Common use of Provider Directory Clause in Contracts

Provider Directory. a. The Health Plan shall mail a Provider Directory to all new Enrollees, including Enrollees who reenrolled after the Open Enrollment period. The Health Plan shall provide the most recently printed Provider Directory and include an addendum listing those physicians, etc., no longer providing services to Enrollees of the Health Plan and those physicians, etc., that have entered into an agreement to provide services to Enrollees of the Health Plan since the Health Plan published the most recently printed Provider Directory. In lieu of the Provider Directory addendum, the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) stating that the most recent listing of Providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's website and provide the Internet address that will take the Enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letter. b. The Provider Directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, current Health Plan Providers. The Provider Directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers that are not accepting new patients. c. The Health Plan shall maintain an online Provider Directory. The Health Plan shall update the online Provider Directory on, at least, a monthly basis. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health Plan's Service Area under contract with the Health Plan, the Provider Directory need only list the chain name. e. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory as follows: (1) Providers are listed in alphabetical order, showing the Provider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are listed by provider type.

Provider Directory. a. The Health Plan shall mail a Provider Directory to all new Enrollees, including Enrollees who reenrolled re-Enrolled after the an Open Enrollment period. This Provider Directory shall be the most current printed Directory with an addendum providing the most up to date Provider information. The Health Plan shall provide the most recently printed Provider Directory update and include an addendum listing those physicians, etc., no longer providing services to Enrollees of the Health Plan and those physicians, etc., that have entered into an agreement to provide services to Enrollees of the Health Plan since the Health Plan published the most recently printed Provider Directory. In lieu of re-print the Provider Directory addendum, the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) stating that the most recent listing of Providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's website and provide the Internet address that will take the Enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directoryleast annually. The Health Plan must obtain the Agency's prior written approval of the letter. b. The Provider Directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, current Health Plan Providers. The Provider Directory shall include, This includes at a minimum, information relating to on PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed licenses midwives, and Ancillary Providers. The Provider Directory shall also identify Providers that are not accepting new patients. c. b. The Health Plan shall maintain an online on-line Provider Directory. The Health Plan shall update the online Such on-line Provider Directory on, shall be updated at least, a monthly basisleast monthly. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. c. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the non-Medicaid Reform FFS program, then the Provider Directory must directory shall include the names of the participating pharmacies. If all pharmacies that are part of a chain and are within the Health Plan's Service Area are under contract with the Health Plan, the Provider Directory need only list the chain name. e. d. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement an advisement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan e. Lists of Providers shall arrange the Provider Directory as follows: (1) Providers are listed in alphabetical orderbe arranged alphabetically, showing the Provider's name and specialty; (2) Providers are listed , and separately, by specialty, in alphabetical order; and. (3) Behavioral f. List of the Health Providers are listed by provider typePlan's behavioral health service centers, including city and county.

Provider Directory. a. The Health Managed Care Plan shall mail ensure its provider directory (either printed or online) matches the most recent provider network file that the Managed Care Plan submitted to the Agency as specified in Section XIV, Reporting Requirements, and the Managed Care Plan Report Guide. b. The Managed Care Plan shall furnish each new enrollee a Provider Directory provider directory and may choose to all new Enrolleesdistribute a printed version of the provider directory via surface mail, including Enrollees who reenrolled after or provide written notification to the Open Enrollment periodenrollee that explains how to obtain the provider directory from the Managed Care Plan’s website. This notification shall also detail how the enrollee can request a hard copy of the printed provider directory from the Managed Care Plan at no charge. The Health Managed Care Plan shall update the printed provider directory at least every six months and provide the most recently printed Provider Directory and include an addendum listing those physiciansprovider directory to new enrollees in accordance with this section. c. When distributing printed provider directories, etc., no longer providing services the Managed Care Plan must append to Enrollees the provider directory a list of the Health Plan providers who have left the network and those physicians, etc., that who have entered into an agreement to provide services to Enrollees of the Health Plan been added since the Health Plan published the most recently directory was printed Provider Directory. In or, in lieu of the Provider Directory addendumappendix to the provider directory, the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) letter stating that the most recent current listing of Providers providers is available by calling the Health Managed Care Plan at its toll-free telephone number and at the Health Managed Care Plan's website ’s website. The letter shall include the telephone number and provide the Internet address that will take the Enrollee enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letterprovider directory. b. d. The Provider Directory provider directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, by current Health Managed Care Plan Providersproviders. The Provider Directory provider directory also shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers providers that are not accepting new patients. c. e. The Health Managed Care Plan shall maintain an online Provider Directory. The Health Plan shall update arrange the online Provider Directory onprovider directory by county as follows: (1) Providers listed by name in alphabetical order, at leastshowing the provider’s specialty; and (2) Providers listed by specialty, a monthly basis. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health Plan's Service Area under contract with the Health Plan, the Provider Directory need only list the chain alphabetical order by name. e. f. In accordance with section s. 1932(b)(3) of the Social Security Act, the Provider Directory provider directory shall include a statement that some Providers providers may choose not to perform certain services based on religious or moral beliefs. f. g. The Health Managed Care Plan is not required to include outpatient-based specialty providers in ambulatory surgical centers and hospital-based providers in the online or printed provider directory. However, the Managed Care Plan shall arrange include these providers in the Provider Directory as follows: (1) Providers are listed in alphabetical order, showing provider network file it submits to the Provider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are listed by provider typeAgency.

Provider Directory. a. The Health Plan shall mail a Provider Directory provider directory to all new Enrolleesenrollees, including Enrollees those who reenrolled after the Open Enrollment open enrollment period. The Health Plan shall provide the most recently printed Provider Directory provider directory and include an addendum listing those physicians, etc., no longer providing services append to Enrollees it a list of the Health Plan providers who have left the network and those physicians, etc., that who have entered into an agreement to provide services to Enrollees of the Health Plan been added since the Health Plan published the most recently printed Provider Directorydirectory was printed. In lieu of the Provider Directory addendumappendix to the provider directory, the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) letter stating that the most recent current listing of Providers providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's website website. The letter shall include the telephone number and provide the Internet address that will take the Enrollee enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letterprovider directory. b. The Provider Directory provider directory shall include the names, locations, office hours, age groups, telephone numbers of, and non-English languages spoken by, by current Health Plan Providersproviders. The Provider Directory provider directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providersancillary providers. The Provider Directory provider directory also shall also identify Providers providers that are not accepting new patients. The provider directory shall also include information on how to determine a provider’s hospital affiliations. Such information must be available online and through customer service. The listing of behavioral health providers shall be grouped by categories (individual practitioners, groups, community mental health centers, and inpatient psychiatric). c. The Health Plan shall maintain an online Provider Directoryprovider directory containing all the information described in subsection 7.b., above. The Health Plan shall update the online Provider Directory on, provider directory at least, a monthly basisleast monthly. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems DevelopmentBMHC each month, even if no changes have occurred. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients people enrolled in the Medicaid FFS fee-for-service program, then the Provider Directory provider directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are all within the Health Plan's Service Area service area are under contract with the Health Plan, the Provider Directory provider directory need list only list the chain name. If the Health Plan uses the Medicaid fee-for-service pharmacy network as its pharmacy network, the provider directory shall include a statement to this effect. e. In accordance with section 1932(b)(3s. 1932(b)(3)(B) of the Social Security Act, the Provider Directory provider directory shall include a statement that some Providers providers may choose not to perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory provider directory as follows: (1) Providers are listed by name in alphabetical order, showing the Providerprovider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are health providers listed in a separate section by county and by provider type, where applicable. WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract g. The Health Plan shall have procedures to inform potential enrollees and enrollees, upon request, of any changes to service delivery and/or the provider network including the following: (1) Up-to-date information about any restrictions on access to providers, including providers who are not taking new patients; (2) An explanation to all potential enrollees that an enrolled family may choose to have all family members served by the same PCP or they may choose different PCPs based on each family member’s needs; (3) Any restrictions on counseling and referral services based on moral or religious grounds within ninety (90) calendar days after adopting the policy with respect to any service.

Provider Directory. a. ‌ The Health Plan shall mail MCO must make available: 3.12.6.1 For MSHO, an integrated Medicare and Medicaid Provider directory; and for MSC+ a Medicaid Provider Directory to all new Enrolleesdirectory that lists the Network Providers within the MCO’s network, including Enrollees who reenrolled after the Open Enrollment periodPrimary Care Providers, physicians including specialists and subspecialists, hospitals, pharmacies, behavioral health providers, and LTSS providers as appropriate. The Health Plan shall provide the most recently printed Directory must include Network Provider Directory and include an addendum listing those physiciansnames, etc., no longer providing services to Enrollees of the Health Plan and those physicians, etc., that have entered into an agreement to provide services to Enrollees of the Health Plan since the Health Plan published the most recently printed Provider Directory. In lieu of the Provider Directory addendum, the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) stating that the most recent listing of Providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's website and provide the Internet address that will take the Enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letter. b. The Provider Directory shall include the namesgroup affiliation, locations, office hourstelephone numbers, telephone numbers ofweb sites as appropriate, and non-English languages spoken by, current Health Plan Providers. The other requirements as specified in the “Provider Directory Guidelines” posted on the STATE’s managed care web site. [42 CFR 438.10(h)(1)] 3.12.6.2 The directory shall indicate the Network Provider’s cultural and linguistic capabilities (including American Sign Language) offered by the Provider or skilled medical interpreter at 3.12.6.3 The directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers that are not accepting new patients. c. The Health Plan shall maintain an online Provider Directory. The Health Plan shall update the online Provider Directory on, at least, a monthly basis. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health Plan's Service Area under contract with the Health Plan, the Provider Directory need only list the chain name. e. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory as follows: (1) Providers are listed in alphabetical order, showing Whether the Network Provider's name office/facility has accommodations for Enrollees with physical disabilities, including offices, exam room(s) and specialty;equipment. (2) Providers are listed by specialty, Information that oral interpretation is available for any language and written information will be available in alphabetical order; andprevalent non-English languages. (3) Behavioral Health Information about how to access mental health, substance use disorder, Elderly Waiver, Home Care, dental, and Medical Emergency and Urgent Care services. The directory must include a statement on how an Enrollee can request a listing of home care agencies and PCPAs. (4) A description of the MCO’s MSC+ and MSHO Care Systems, Care Coordination systems, Case Management systems, and any other distinguishing information that will assist the Enrollee in making a decision to enroll in the MCO’s MSC+ and/or MSHO product. If the MCO limits access to Providers by use of a Care System model, the MCO must describe which Providers are listed available to Enrollees based on the Care System chosen. (5) Information concerning the selection process, including a statement that the Enrollee must select an MCO in which their Primary Care Provider or specialist participates if they wish to continue to obtain services from him or her. (6) Any restrictions on the Enrollee’s freedom of choice among Network Providers. (7) Information regarding open access of Family Planning Services and services prescribed by provider typeMinnesota Statutes, §62Q.14, and the availability of transitional services. (8) Any language required by the Minnesota Department of Health (MDH) in order to provide protection and additional information for consumers of health care. Currently this language includes the following: “Enrolling in this health plan does not guarantee you can go to a particular Provider on this list. If you want to make sure, call that Provider to ask whether he or she is still part of this health plan. Also ask if he or she is accepting new patients. This health plan may not cover all your health care costs. Read your contract, or ‘Evidence of Coverage,’ carefully to find out what is covered.” If MDH determines that new language needs to be included, the MCO will incorporate it into the next available update of the Provider Directory.

Provider Directory. a. The Health Managed Care Plan shall mail or hand deliver a Provider Directory provider directory to all new Enrolleesenrollees, including Enrollees those who reenrolled after the Open Enrollment open enrollment period. The Health Managed Care Plan shall provide the most recently printed Provider Directory provider directory and include an addendum listing those physicians, etc., no longer providing services append to Enrollees it a list of the Health Plan providers who have left the network and those physicians, etc., that who have entered into an agreement to provide services to Enrollees of the Health Plan been added since the Health Plan published the most recently printed Provider Directorydirectory was printed. In lieu of the Provider Directory addendum, appendix to the Health provider directory the Managed Care Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) letter stating that the most recent current listing of Providers providers is available by calling the Health Managed Care Plan at its toll-free telephone number and at the Health Managed Care Plan's website website. The letter shall include the telephone number and provide the Internet address that will take the Enrollee enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letterprovider directory. b. The Provider Directory provider directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, by current Health Managed Care Plan Providersproviders. The Provider Directory provider directory also shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers providers that are not accepting new patients. c. The Health Plan shall maintain an online Provider Directory. The Health Plan shall update the online Provider Directory on, at least, a monthly basis. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health Plan's Service Area under contract with the Health Plan, the Provider Directory need only list the chain name. e. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory provider directory by county as follows: (1) Providers are listed by name in alphabetical order, showing the Providerprovider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are health providers listed in a separate section by provider type, where applicable. d. The Managed Care Plan shall maintain an accurate and complete online provider directory containing all the information described in this subsection as well as information about licensure or registration, specialty credentials and other certifications, and specific performance indicators. The online provider directory must be searchable by: (1) Name, (2) Provider type, (3) Distance from the enrollee's address, (4) Zip code, and (5) Whether the provider is accepting new patients. The online provider directory shall also have the capability to compare the availability of providers to network adequacy standards and accept and display feedback from each provider's patients. The Managed Care Plan shall update the online provider directory at least monthly. The Managed Care Plan shall file an attestation to this effect with the Agency each month, even if no changes have occurred. (See s. 409.967(2)(c), F.S.) e. In accordance with s. 1932(b)(3) of the Social Security Act, the provider directory shall include a statement that some providers may choose not to perform certain services based on religious or moral beliefs. f. The Managed Care Plan shall have procedures to inform potential enrollees and enrollees, upon request, of any changes to service delivery and/or the provider network including the following: (1) Up-to-date information about any restrictions on access to providers, including providers who are not taking new patients; (2) Any restrictions on counseling and referral services based on moral or religious grounds within ninety (90) days after adopting the policy with respect to any service.

Provider Directory. a. The Health Plan shall mail a Provider Directory provider directory to all new Enrolleesenrollees, including Enrollees those who reenrolled after the Open Enrollment open enrollment period. The Health Plan shall provide the most recently printed Provider Directory provider directory and include an addendum listing those physicians, etc., no longer providing services append to Enrollees it a list of the Health Plan providers who have left the network and those physicians, etc., that who have entered into an agreement to provide services to Enrollees of the Health Plan been added since the Health Plan published the most recently printed Provider Directorydirectory was printed. In lieu of the Provider Directory addendum, appendix to the provider directory the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) letter stating that the most recent current listing of Providers providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's website ’s website. The letter shall include the telephone number and provide the Internet address that will take the Enrollee enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letterprovider directory. b. The Provider Directory provider directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, by current Health Plan Providersproviders. The Provider Directory provider directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providersancillary providers. The Provider Directory provider directory also shall also identify Providers providers that are not accepting new patients. The provider directory shall also include information on how to determine a provider’s hospital affiliations. Such information must be available online and through customer service. c. The Health Plan shall maintain an online Provider Directoryprovider directory containing all the information described in subsection 7.b., above. The Health Plan shall update the online Provider Directory on, provider directory at least, a monthly basisleast monthly. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems DevelopmentBMHC each month, even if no changes have occurred. d. If the a Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients people enrolled in the Medicaid FFS fee-for-service program, then the Provider Directory provider directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are all within the Health Plan's Service Area ’s service area are under contract with the Health Plan, the Provider Directory provider directory need list only list the chain name. e. In accordance with section s. 1932(b)(3) of the Social Security Act, the Provider Directory provider directory shall include a statement that some Providers providers may choose not to perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory provider directory as follows: (1) Providers are listed by name in alphabetical order, showing the Provider's name and provider’s specialty; (2) Providers are listed by specialty, in alphabetical order; andand AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract (3) (Reform Health Plans and non-Reform HMOs only) Behavioral Health Providers are health providers listed in a separate section by county and by provider type, where applicable. g. The Health Plan shall have procedures to inform potential enrollees and enrollees, upon request, of any changes to service delivery and/or the provider network including the following: (1) Up-to-date information about any restrictions on access to providers, including providers who are not taking new patients; (2) An explanation to all potential enrollees that an enrolled family may choose to have all family members served by the same PCP or they may choose different PCPs based on each family member’s needs; (3) Any restrictions on counseling and referral services based on moral or religious grounds within ninety (90) days after adopting the policy with respect to any service.

Provider Directory. a. The Health Plan shall mail a Provider Directory provider directory to all new Enrolleesenrollees, including Enrollees those who reenrolled after the Open Enrollment open enrollment period. The Health Plan shall provide the most recently printed Provider Directory provider directory and include an addendum listing those physicians, etc., no longer providing services append to Enrollees it a list of the Health Plan providers who have left the network and those physicians, etc., that who have entered into an agreement to provide services to Enrollees of the Health Plan been added since the Health Plan published the most recently printed Provider Directorydirectory was printed. In lieu of the Provider Directory addendum, appendix to the provider directory the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) letter stating that the most recent current listing of Providers providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's website website. The letter shall include the telephone number and provide the Internet address that will take the Enrollee enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letterprovider directory. b. The Provider Directory provider directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, by current Health Plan Providersproviders. The Provider Directory provider directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providersancillary providers. The Provider Directory provider directory also shall also identify Providers providers that are not accepting new patients. The provider directory shall also include information on how to determine a provider’s hospital affiliations. Such information must be available online and through customer service. c. The Health Plan shall maintain an online Provider Directoryprovider directory containing all the information described in subsection 7.b., above. The Health Plan shall update the online Provider Directory on, provider directory at least, a monthly basisleast monthly. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems DevelopmentBMHC each month, even if no changes have occurred. d. If the a Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients people enrolled in the Medicaid FFS fee-for-service program, then the Provider Directory provider directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are all within the Health Plan's Service Area service area are under contract with the Health Plan, the Provider Directory provider directory need list only list the chain name. e. In accordance with section s. 1932(b)(3) of the Social Security Act, the Provider Directory provider directory shall include a statement that some Providers providers may choose not to perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory provider directory as follows: (1) Providers are listed by name in alphabetical order, showing the Providerprovider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; andand WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract (3) (Reform Health Plans and non-Reform HMOs only) Behavioral health providers listed in a separate section by county and by provider type, where applicable. g. The Health Plan shall have procedures to inform potential enrollees and enrollees, upon request, of any changes to service delivery and/or the provider network including the following: (1) Up-to-date information about any restrictions on access to providers, including providers who are not taking new patients; (2) An explanation to all potential enrollees that an enrolled family may choose to have all family members served by the same PCP or they may choose different PCPs based on each family member’s needs; (3) Behavioral Health Providers are listed by provider typeAny restrictions on counseling and referral services based on moral or religious grounds within ninety (90) days after adopting the policy with respect to any service.

Provider Directory. a. The Health Plan PSN shall mail a Provider Directory to all new Enrollees, including Enrollees who reenrolled after the Open Enrollment period. The Health Plan PSN shall provide the most recently printed Provider Directory and include an addendum listing those physicians, etc., no longer providing services to Enrollees of the Health Plan PSN and those physicians, etc., that have entered into an agreement to provide services to Enrollees of the Health Plan PSN since the Health Plan PSN published the most recently printed Provider Directory. In lieu of the Provider Directory addendum, the Health Plan PSN may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) stating that the most recent listing of Providers is available by calling the Health Plan PSN at its toll-free telephone number and at the Health PlanPSN's website and provide the Internet address that will take the Enrollee directly to the online Provider Directory, without having to go to the Health PlanPSN's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan PSN must obtain the Agency's prior written approval of the letter. b. The Provider Directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, current Health Plan PSN Providers. The Provider Directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers that are not accepting new patients. c. The Health Plan PSN shall maintain an online on-line Provider Directory. The Health Plan PSN shall update the online Provider Directory on, at least, a monthly basis. The Health Plan PSN shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan PSN elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health PlanPSN's Service Area are under contract with the Health PlanPSN, the Provider Directory need only list the chain name. e. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan PSN shall arrange the Provider Directory as follows: (1) Providers are listed in alphabetical order, showing the Provider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are listed by provider type.

Provider Directory. a. The Health Plan shall mail a Provider Directory to all new Enrollees, including Enrollees who reenrolled after the Open Enrollment period. The Health Plan shall provide the most recently printed Provider Directory and include an addendum listing those physicians, etc., no longer providing services to Enrollees of the Health Plan and those physicians, etc., that have entered into an agreement to provide services to Enrollees of the Health Plan since the Health Plan published the most recently printed Provider Directory. In lieu of the Provider Directory addendum, the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) stating that the most recent listing of Providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's ’s website and provide the Internet address that will take the Enrollee directly to the online Provider Directory, without having to go to the Health Plan's ’s home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's ’s prior written approval of the letter. b. The Provider Directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, current Health Plan Providers. The Provider Directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers that are not accepting new patients. c. The Health Plan shall maintain an online Provider Directory. The Health Plan shall update the online Provider Directory on, at least, a monthly basis. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health Plan's ’s Service Area under contract with the Health Plan, the Provider Directory need only list the chain name. e. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory as follows: (1) Providers are listed in alphabetical order, showing the Provider's ’s name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are listed by provider type.

Provider Directory. a. The Health Plan shall mail a Provider Directory provider directory to all new Enrolleesenrollees, including Enrollees those who reenrolled after the Open Enrollment open enrollment period. The Health Plan shall provide the most recently printed Provider Directory provider directory and include an addendum listing those physicians, etc., no longer providing services append to Enrollees it a list of the Health Plan providers who have left the network and those physicians, etc., that who have entered into an agreement to provide services to Enrollees of the Health Plan been added since the Health Plan published the most recently printed Provider Directorydirectory was printed. In lieu of the Provider Directory addendum, appendix to the provider directory the Health Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) letter stating that the most recent current listing of Providers providers is available by calling the Health Plan at its toll-free telephone number and at the Health Plan's website website. The letter shall include the telephone number and provide the Internet address that will take the Enrollee enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letterprovider directory. b. The Provider Directory provider directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, by current Health Plan Providersproviders. The Provider Directory provider directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providersancillary providers. The Provider Directory provider directory also shall also identify Providers providers that are not accepting new patients. The provider directory shall also include information on how to determine a provider’s hospital affiliations. Such information must be available online and through customer service. c. The Health Plan shall maintain an online Provider Directoryprovider directory containing all the information described in subsection 7.b., above. The Health Plan shall update the online Provider Directory on, provider directory at least, a monthly basisleast monthly. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems DevelopmentBMHC each month, even if no changes have occurred. d. If the a Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients people enrolled in the Medicaid FFS fee-for-service program, then the Provider Directory provider directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are all within the Health Plan's Service Area service area are under contract with the Health Plan, the Provider Directory provider directory need list only list the chain name. e. In accordance with section s. 1932(b)(3) of the Social Security Act, the Provider Directory provider directory shall include a statement that some Providers providers may choose not to perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory provider directory as follows: (1) Providers are listed by name in alphabetical order, showing the Providerprovider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; andand HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract (3) (Reform Health Plans and non-Reform HMOs only) Behavioral Health Providers are health providers listed in a separate section by county and by provider type, where applicable. g. The Health Plan shall have procedures to inform potential enrollees and enrollees, upon request, of any changes to service delivery and/or the provider network including the following: (1) Up-to-date information about any restrictions on access to providers, including providers who are not taking new patients; (2) An explanation to all potential enrollees that an enrolled family may choose to have all family members served by the same PCP or they may choose different PCPs based on each family member’s needs; (3) Any restrictions on counseling and referral services based on moral or religious grounds within ninety (90) days after adopting the policy with respect to any service.

Provider Directory. a. The Health Managed Care Plan shall mail or hand deliver a Provider Directory provider directory to all new Enrolleesenrollees, including Enrollees those who reenrolled after the Open Enrollment open enrollment period. The Health Managed Care Plan shall provide the most recently printed Provider Directory provider directory and include an addendum listing those physicians, etc., no longer providing services append to Enrollees it a list of the Health Plan providers who have left the network and those physicians, etc., that who have entered into an agreement to provide services to Enrollees of the Health Plan been added since the Health Plan published the most recently printed Provider Directorydirectory was printed. In lieu of the Provider Directory addendum, appendix to the Health provider directory the Managed Care Plan may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) letter stating that the most recent current listing of Providers providers is available by calling the Health Managed Care Plan at its toll-free telephone number and at the Health Managed Care Plan's website website. The letter shall include the telephone number and provide the Internet address that will take the Enrollee enrollee directly to the online Provider Directory, without having to go to the Health Plan's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan must obtain the Agency's prior written approval of the letterprovider directory. b. The Provider Directory provider directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, by current Health Managed Care Plan Providersproviders. The Provider Directory provider directory also shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers providers that are not accepting new patients. c. The Health Plan shall maintain an online Provider Directory. The Health Plan shall update the online Provider Directory on, at least, a monthly basis. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health Plan's Service Area under contract with the Health Plan, the Provider Directory need only list the chain name. e. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory provider directory by county as follows: (1) Providers are listed by name in alphabetical order, showing the Providerprovider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are health providers listed in a separate section by provider type, where applicable. d. The Managed Care Plan shall maintain an accurate and complete online provider directory containing all the information described in this subsection as well as information about licensure or registration, specialty credentials and other certifications, and specific performance indicators. The online provider directory must be searchable by: (1) Name, (2) Provider type, (3) Distance from the enrollee’s address, (4) Zip code, and (5) Whether the provider is accepting new patients. The online provider directory shall also have the capability to compare the availability of providers to network adequacy standards and accept and display feedback from each provider’s patients. The Managed Care Plan shall update the online provider directory at least monthly. The Managed Care Plan shall file an attestation to this effect with the Agency each month, even if no changes have occurred. (See s. 409.967(2)(c), F.S.) e. In accordance with s. 1932(b)(3) of the Social Security Act, the provider directory shall include a statement that some providers may choose not to perform certain services based on religious or moral beliefs. f. The Managed Care Plan shall have procedures to inform potential enrollees and enrollees, upon request, of any changes to service delivery and/or the provider network including the following: (1) Up-to-date information about any restrictions on access to providers, including providers who are not taking new patients; (2) Any restrictions on counseling and referral services based on moral or religious grounds within ninety (90) days after adopting the policy with respect to any service.

Provider Directory. a. The Health Plan PSN shall mail a Provider Directory to all new Enrollees, including Enrollees who reenrolled reenrolledre-Enrolled after the an Open Enrollment period. The Health Plan PSN shall provide the most recently printed Provider Directory and include an addendum listing those physicians, etc., no longer providing services to Enrollees of the Health Plan PSN and those physicians, etc., that have entered into an agreement to provide services to Enrollees of the Health Plan PSN since the Health Plan PSN published the most recently printed Provider Directory. In lieu of the Provider Directory addendum, the Health Plan PSN may enclose a letter, in Times New Roman font, and at the fourth-grade reading level (as is required of all documents mailed to Enrollees) stating that the most recent listing of Providers is available by calling the Health Plan PSN at its toll-free telephone number and at the Health PlanPSN's website and provide the Internet address that will take the Enrollee directly to the online Provider Directory, without having to go to the Health PlanPSN's home page or any other website as a prerequisite to viewing the online Provider Directory. The Health Plan PSN must obtain the Agency's prior written approval of the letter.This Provider Directory shall be the most current printed Directory with an addendum providing the most up to date Provider information. The PSN shall update and re-print the Provider Directory at least annually. The Provider Directory shall include names, locations, office hours, telephone numbers of, and non-English languages spoken by, current PSN Providers. This includes at a minimum, information on PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers that are not accepting new patients. b. The Provider Directory shall include the names, locations, office hours, telephone numbers of, and non-English languages spoken by, current Health Plan PSN Providers. The Provider Directory shall include, at a minimum, information relating to PCPs, specialists, pharmacies, hospitals, certified nurse midwives and licensed midwives, and Ancillary Providers. The Provider Directory shall also identify Providers that are not accepting new patients. c. The Health Plan shall maintain an online Provider Directory. The Health Plan shall update the online Provider Directory on, at least, a monthly basis. The Health Plan shall file an attestation to this effect with the Bureau of Managed Health Care and the Bureau of Health Systems Development. d. If the Health Plan elects to use a more restrictive pharmacy network than the network available to Medicaid Recipients enrolled in the Medicaid FFS program, then the Provider Directory must include the names of the participating pharmacies. If all pharmacies are part of a chain and are within the Health Plan's Service Area under contract with the Health Plan, the Provider Directory need only list the chain name. e. In accordance with section 1932(b)(3) of the Social Security Act, the Provider Directory shall include a statement that some Providers may not perform certain services based on religious or moral beliefs. f. The Health Plan shall arrange the Provider Directory as follows: (1) Providers are listed in alphabetical order, showing the Provider's name and specialty; (2) Providers are listed by specialty, in alphabetical order; and (3) Behavioral Health Providers are listed by provider type.