PROVIDER NETWORK AND ACCESS REQUIREMENTS Sample Clauses

PROVIDER NETWORK AND ACCESS REQUIREMENTS. ‌ The HMO must provide medical care to its BadgerCare Plus and/or Medicaid SSI members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus and/or Medicaid SSI members within the area served by the HMO. A. Use of BadgerCare Plus and/or Medicaid SSI Enrolled Providers‌ Except in emergency situations, the HMO must use only Medicaid enrolled providers for the provision of covered services. The Department reserves the right to withhold from the capitation payments the monies related to services provided by non-enrolled providers, at the FFS rate for those services, unless the HMO can demonstrate that it reasonably believed, based on the information provided by the Department, that the provider was Medicaid enrolled at the time the HMO reimbursed the provider for service provision. The Wis. Adm. Code, Ch. DHS 105 and the ForwardHealth Handbook, contains information regarding provider certification requirements. The HMO must require every physician providing services to members to have a Provider Number or National Provider Identifier (NPI). B. Protocols/Standards to Ensure Access‌ The HMO must have written protocols to ensure that members have access to screening, diagnosis and referral and appropriate treatment for those conditions and services covered under BadgerCare Plus and Medicaid SSI programs. The HMO’s protocols must include training and information for providers in their network, in order to promote and develop provider skills in responding to the needs of persons with mental, physical and developmental disabilities. Training should include clinical and communication issues and the role of care coordinators. For members with special health care needs, where a course of treatment or regular case monitoring is needed, the HMO must have mechanisms in place to allow members to directly access a specialist, as appropriate, for the member’s condition and identified needs. C. Written Standards for Accessibility of Care‌ 1. The HMO must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the HMO. The standards must include the following: • Waiting times for care at facilities; • Waiting times for appointments; • Statement that providers’ hours of operation do not discriminate against BadgerCare Plus and/or Medicaid SSI members; and • Whether or not provider(s) speak the member’s language. 2. The HMO’s...
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PROVIDER NETWORK AND ACCESS REQUIREMENTS. The PIHP must provide medical care to its FCMH members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus and/or Medicaid SSI members within the area served by the PIHP.
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PROVIDER NETWORK AND ACCESS REQUIREMENTS. The HMO must provide medical care to its Medicaid and BadgerCare enrollees that is as accessible to them, in terms of timeliness, amount, duration, and scope, as those services are to non-enrolled Medicaid and BadgerCare recipients within the area served by the HMO.
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PROVIDER NETWORK AND ACCESS REQUIREMENTS. ‌ The County must provide medical care to its BadgerCare Plus members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus members within the area served by the County. A. Protocols/Standards to Ensure Access The County must have written protocols to ensure that members have access to screening, diagnosis and referral and appropriate treatment for those conditions and services covered under BadgerCare Plus programs. The County’s protocols must include training and information for providers in their network, in order to promote and develop provider skills in responding to the needs of persons with limited English proficiency, mental, physical and developmental disabilities. Training should include clinical and communication issues and the role of care coordinators. For members with special health care needs, where a course of treatment or regular case monitoring is needed, the County must have mechanisms in place to allow members to directly access a specialist, as appropriate, for the member’s condition and identified needs. B. Written Standards for Accessibility of Care 1. The County must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the County. The standards must include the following: a. Waiting times for care at facilities; b. Waiting times for appointments; c. Statement that providers’ hours of operation do not discriminate against BadgerCare Plus members; and d. Whether or not provider(s) speak the member’s language. 2. The County may not prohibit, or otherwise restrict, a health care professional acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee who is his or her patient, for the following: a. The enrollee’s health status, medical care, or treatment options, including any alternative treatment that may be self- administered. b. Any information the enrollee needs in order to decide among all relevant treatment options. c. The risks, benefits, and consequences of treatment or non- treatment. d. The enrollee’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions. These minimum requirements shall not release the County from the requirement to provide or arrange for the provision of any medically necessary covered service required...
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PROVIDER NETWORK AND ACCESS REQUIREMENTS. The County must provide medical care to its BadgerCare Plus members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus members within the area served by the County. A. Protocols/Standards to Ensure Access The County must have written protocols to ensure that members have access to screening, diagnosis and referral and appropriate treatment for those conditions and services covered under BadgerCare Plus programs. The County’s protocols must include training and information for providers in their network, in order to promote and develop provider skills in responding to the needs of persons with limited English proficiency, mental, physical and developmental disabilities. Training should include clinical and communication issues and the role of care coordinators. For members with special health care needs, where a course of treatment or regular case monitoring is needed, the County must have mechanisms in place to allow members to directly access a specialist, as appropriate, for the member’s condition and identified needs. B. Written Standards for Accessibility of Care
Sample 1
PROVIDER NETWORK AND ACCESS REQUIREMENTS. The HMO must provide medical care to its BadgerCare Plus and/or Medicaid SSI members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus and/or Medicaid SSI members within the area served by the HMO. A. Use of BadgerCare Plus and/or Medicaid SSI Certified Providers B. Protocols/Standards to Ensure Access
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PROVIDER NETWORK AND ACCESS REQUIREMENTS. The County must provide medical care to its BadgerCare Plus members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus members within the area served by the County.
Sample 1
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PROVIDER NETWORK AND ACCESS REQUIREMENTS. ‌ The County PIHP must provide services covered by this Contract to itsmembers that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non- enrolled Medicaid members within the area served by the County PIHP. A. Use of Medicaid Enrolled Providers Except in emergency situations, the County PIHP must use only Medicaid enrolled providers for the provision of covered services. The Department reserves the right to withhold from the capitation development the costs related to services provided by non- enrolled providers, at the FFS rate for those services, unless the County PIHP can demonstrate that it reasonably believed, based on the information provided by the Department, that the provider was Medicaid enrolled at the time the County PIHP reimbursed the provider for service provision. The Wis. Adm. Code, Ch. DHS 105 and the ForwardHealth Handbook, contains information regarding provider certification requirements. The County PIHP must require every physician providing services to members to have a Provider Number or National Provider Identifier (NPI). The Department requires that Medicaid-enrolled providers undergo periodic revalidation. During revalidation, providers update their enrollment information with ForwardHealth, and sign the Wisconsin Medicaid Provider Agreement and Acknowledgement of Terms of Participation. Providers who fail to revalidate are terminated from Wisconsin Medicaid. B. Protocols/Standards to Ensure Access The County PIHP must have written protocols to ensure that members have access to screening, diagnosis and referral and appropriate treatment for those conditions and services covered under the County PIHP. The County PIHP’s protocols must include training and information for providers in their network, in order to promote and develop provider skills in responding to the needs of persons with limited English proficiency, mental, physical and developmental disabilities. Training should include clinical and communication issues and the role of care coordinators. For members with special health care needs, where a course of treatment or regular case monitoring is needed, the County PIHP must have mechanisms in place to allow members to directly access a specialist, as appropriate, for the member’s condition and identified needs. C. Written Standards for Accessibility of Care 1. The County PIHP must have written standards for the accessibility of care and services. These standards must be co...
Sample 1
PROVIDER NETWORK AND ACCESS REQUIREMENTS. ‌ The PIHP must demonstrate covered services within the provider network are available and accessible to members per 42 CFR § 438.206, 438.68, and 438.14 and has the capacity to serve expected enrollment in its service area per 42 CFR § 438.207. The PIHP must establish provider network access, availability, and capacity expectations within provider’s contracts, to include standards, protocols, methods of monitoring, reporting, and remediation. A. Availability and Accessibility‌ The PIHP must establish mechanisms to ensure compliance by network providers; regularly monitor to determine compliance; take corrective action if there is a failure to comply by a network provider; and make readily available to the department upon request records of such actions. Provider Network The PIHP must: a. Maintain and monitor a network of appropriate providers that is supported by written agreements and is sufficient to provide adequate access to all services covered under the contract for all members, including those with limited English proficiency or physical or mental disabilities. b. Provide female members with direct access to a women's health specialist within the provider network for covered care necessary to provide women's routine and preventive health care services. This is in addition to the member's designated source of primary care if that source is not a women's health specialist. c. Provide for a second opinion from a network provider or arranges for the member to obtain one outside the network, at no cost to the member. d. Provide necessary services, covered under the contract, to a particular enrollee, the PIHP must adequately and timely cover these services out of network for the member, for as long as the PIHP’s provider network is unable to provide them. e. Coordinate with out-of-network providers for payment and ensure the cost to the member is no greater than it would be if the services were furnished within the network. f. Reimburse for emergency services provided out-of-network at a cost to the member no greater than if the services were provided in-network. g. Demonstrates network providers are credentialed as required by 42 CFR § 438.214. h. Demonstrates network providers are credentialed as required by 42 CFR § 438.214. Furnishing of Services and Timely Access The PIHP must: a. Require network providers meet standards for timely access to care and services, considering the urgency of the need for services. b. Ensure network providers offer hours...
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Related to PROVIDER NETWORK AND ACCESS REQUIREMENTS

  • Provider Network The Panel of health service Providers with which the Contractor contracts for the provision of covered services to Members and Out-of-network Providers administering services to Members.

  • Data Access Access to Contract and State Data The Contractor shall provide to the Client Agency access to any data, as defined in Conn. Gen Stat. Sec. 4e-1, concerning the Contract and the Client Agency that are in the possession or control of the Contractor upon demand and shall provide the data to the Client Agency in a format prescribed by the Client Agency and the State Auditors of Public Accounts at no additional cost.

  • System Access CUSTOMER agrees to provide to PROVIDER, at CUSTOMER’S expense, necessary access to the mainframe computer and related information technology systems (the “System”) on which CUSTOMER data is processed during the times (the “Service Hours”) specified in the PSAs, subject to reasonable downtime for utility outages, maintenance, performance difficulties and the like. In the event of a change in the Service Hours, CUSTOMER will provide PROVIDER with at least fifteen (15) calendar days written notice of such change.

  • System Upgrade Facilities and System Deliverability Upgrades Connecting Transmission Owner shall design, procure, construct, install, and own the System Upgrade Facilities and System Deliverability Upgrades described in Appendix A hereto. The responsibility of the Developer for costs related to System Upgrade Facilities and System Deliverability Upgrades shall be determined in accordance with the provisions of Attachment S to the NYISO OATT.

  • Network Access TENANT may find it necessary to purchase a network interface card, wireless PC card or other hardware in order to connect to the internet service. LANDLORD is not responsible for the purchase of these items and LANDLORD cannot guarantee compatibility with any device TENANT may have. The computer and network card must have software installed that supports the Internet Protocol commonly referred to as TCP/IP. Any conflicts between the software compatibility of the network and the TENANT’S computer operating system or any other feature will be the responsibility of the TENANT to resolve. LANDLORD will not be responsible for software issues related to the user’s personal computer.

  • Records Maintenance and Access Grantee must maintain all financial records relating to this Grant in accordance with generally accepted accounting principles. In addition, Grantee must maintain any other records, whether in paper, electronic or other form, pertinent to this Grant in such a manner as to clearly document Grantee’s performance. All financial records and other records, whether in paper, electronic or other form, that are pertinent to this Grant, are collectively referred to as “Records.” Grantee acknowledges and agrees Agency and the Oregon Secretary of State's Office and the federal government and their duly authorized representatives will have access to all Records to perform examinations and audits and make excerpts and transcripts. Grantee must retain and keep accessible all Records for a minimum of six (6) years, or such longer period as may be required by applicable law, following termination of this Grant, or until the conclusion of any audit, controversy or litigation arising out of or related to this Grant, whichever date is later.

  • User Access Transfer Agent shall have a process to promptly disable access to Fund Data by any Transfer Agent personnel who no longer requires such access. Transfer Agent will also promptly remove access of Fund personnel upon receipt of notification from Fund.

  • Originating Switched Access Detail Usage Data A category 1101XX record as defined in the EMI Telcordia Practice BR-010-200- 010.

  • Proposed Policies and Procedures Regarding New Online Content and Functionality By October 31, 2017, the School will submit to OCR for its review and approval proposed policies and procedures (“the Plan for New Content”) to ensure that all new, newly-added, or modified online content and functionality will be accessible to people with disabilities as measured by conformance to the Benchmarks for Measuring Accessibility set forth above, except where doing so would impose a fundamental alteration or undue burden. a) When fundamental alteration or undue burden defenses apply, the Plan for New Content will require the School to provide equally effective alternative access. The Plan for New Content will require the School, in providing equally effective alternate access, to take any actions that do not result in a fundamental alteration or undue financial and administrative burdens, but nevertheless ensure that, to the maximum extent possible, individuals with disabilities receive the same benefits or services as their nondisabled peers. To provide equally effective alternate access, alternates are not required to produce the identical result or level of achievement for persons with and without disabilities, but must afford persons with disabilities equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement, in the most integrated setting appropriate to the person’s needs. b) The Plan for New Content must include sufficient quality assurance procedures, backed by adequate personnel and financial resources, for full implementation. This provision also applies to the School’s online content and functionality developed by, maintained by, or offered through a third-party vendor or by using open sources. c) Within thirty (30) days of receiving OCR’s approval of the Plan for New Content, the School will officially adopt, and fully implement the amended policies and procedures.

  • XXX Hosting 10.1 XXX Hosting is not required for resale in the BellSouth region.

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