Provider Network Standards. In accordance with Rule 0800-02-01-.06 of the Official Compilation of the Rules and Regulations of the State of Tennessee, the Contractor shall provide an Employee with a choice of three (3) Providers within the Employee's community. For purposes of that requirement, the term "community" means fifty (50) miles from the Employee's residence or place of employment. To meet this requirement, the Contractor shall use its best efforts to select and contract with at least three (3) Primary Care Physicians and a Health Facility located within at least fifty (50) miles of each Employee's residence. The Contractor shall also use its best efforts to select and contract with at least three (3) orthopedic and neurosurgery specialists located within sixty (60) miles of each Employee's residence. The Contractor shall have an accessibility analysis performed on an annual basis by a qualified third party for the purpose of establishing whether the above standards are being met and provide the results of the analysis to the State. Notwithstanding the numerical standards set forth above (e.g., three (3) Primary Care Physicians and a Health Facility), the Contractor shall use its best efforts to secure, for each county in Tennessee, sufficient Network participation by hospitals, physicians, ambulatory surgical facilities, and other health care providers to ensure an adequate distribution of, and reasonable access to, participating Providers from a geographic and service standpoint. The Contractor and the State shall reevaluate for each county in Tennessee the ratios of health care providers to Employees on an on-going basis and the Contractor shall add health care providers as needed.
Provider Network Standards. For each Employee residing in an urban area, the Contractor shall use its best efforts to select and contract with at least three (3) retail pharmacies located within at least five (5) miles of the Employee's residence. For each Employee residing in a suburban area, the Contractor shall use its best efforts to select and contract with at least three (3) retail pharmacies located within ten (10) miles of the Employee’s residence. For each Employee residing in a rural area, the Contractor shall use its best efforts to select and contract with at least three (3) retail pharmacies located within at least fifteen (15) miles of the Employee's residence. Notwithstanding the numerical standards set forth above, the Contractor shall use its best efforts to secure, for each county in Tennessee, sufficient Network participation by retail pharmacies to ensure an adequate distribution of, and reasonable access to, participating Providers from a geographic and service standpoint. The Contractor and the State shall reevaluate for each county in Tennessee the ratios of retail pharmacies participating in the Network to Employees on an on-going basis and the Contractor shall add such pharmacies as needed.
