Provider Hours Operation. In accordance with 42 CFR §438.206(c)(1)(ii), the MCO must ensure that the hours of operation of its providers are convenient, do not discriminate against enrollees, and are no less than the hours of operation offered to commercial enrollees or comparable to Medicaid FFS. MCOs must ensure that waiting times at sites of care are kept to a minimum and ensure that the waiting time standard for Medicaid enrollees is the same standard used for commercial enrollees. Providers cannot discriminate against Medicaid enrollees in the order that patients are seen or in the order that appointments are given (providers are not permitted to schedule Medicaid-only days). In accordance with 42 CFR §438.206(c)(iii), when Medically Necessary, the MCO must make services available twenty-four (24) hours a day, seven (7) days a week. In accordance with 42 CFR §438.206(c)(iv), the MCO must establish a mechanism to ensure that providers comply with the access standards set forth in this contract. The MCO must regularly measure the extent to which providers in the network comply with these requirements and take remedial action if necessary.
Appears in 4 contracts
Samples: Model Purchase of Service Provider Agreement, Service Provider Agreement, Model Purchase of Service Provider Agreement
Provider Hours Operation. In accordance with 42 CFR §438.206(c)(1)(ii), the MCO must ensure that the hours of operation of its providers are convenient, do not discriminate against enrollees, and are no less than the hours of operation offered to commercial enrollees or comparable to Medicaid FFS. MCOs must ensure that waiting times at sites of care are kept to a minimum and ensure that the waiting time standard for Medicaid and WVCHIP enrollees is the same standard used for commercial enrollees. Providers cannot discriminate against Medicaid and WVCHIP enrollees in the order that patients are seen or in the order that appointments are given (providers are not permitted to schedule Medicaid/WVCHIP-only days). In accordance with 42 CFR §438.206(c)(iii), when Medically Necessary, the MCO must make services available twenty-four (24) hours a day, seven (7) days a week. In accordance with 42 CFR §438.206(c)(iv), the MCO must establish a mechanism to ensure that providers comply with the access standards set forth in this contract. The MCO must regularly measure the extent to which providers in the network comply with these requirements and take remedial action if necessary.
Appears in 2 contracts
Samples: Service Provider Agreement, Service Provider Agreement
