Common use of Provider Network Requirements Clause in Contracts

Provider Network Requirements. The Contractor shall develop and maintain a provider network in compliance with the terms of this section. Individuals with disabilities and chronic health conditions often spend years finding providers with the appropriate clinical knowledge and competencies to meet their needs. The Contractor shall implement strategies to ensure the maintenance of these established provider relationships and develop a network able to handle the special health care needs of the Hoosier Care Connect population. In accordance with 42 CFR 438.3(l) the Contractor must allow each member to choose his or her health professional to the extent possible and appropriate. The Contractor must ensure that its provider network is supported by written provider agreements, is available and geographically accessible and provides an adequate number of facilities, physicians, pharmacies, ancillary providers, service locations and personnel for the provision of high-quality covered services for its members, in accordance with 42 CFR 438.206. The Contractor must also ensure that all of its contracted providers can respond to the cultural, racial and linguistic needs of its members. The Contractor must ensure all network providers who, in accordance with IHCP policy, are provider types eligible and required to enroll as an IHCP provider, are enrolled IHCP providers. In some cases, members may receive out-of-network services. In order to receive reimbursement from the Contractor, out-of-network providers must be IHCP providers. The Contractor shall encourage out-of- network providers, particularly emergency services providers, to enroll in the IHCP. Further information about IHCP Provider Enrollment is located at: xxxx://xxxxxxxx.xxxxxxxxxxxxxxx.xxx/become-a-provider/ihcp-provider-enrollment- transactions.aspx