Provider Network Submission Assessment. The department shall utilize the results of each network submission to determine the adequacy of the CONTRACTOR’s Provider network. The CONTRACTOR shall:
6.4.1. Respond in writing to the Department for all instances where the assessment and the Failure Severity Index Report reflects a failure for a Provider specialty and county.
6.4.2. The Failure Severity Index Report will assess the CONTRACTORs network adequacy utilizing a weighted scale of final Failure Severity from low to high. For all mid-high and high network failures found on the report the MCO’s response to the Department must include a plan of action for addressing the assessment failure.
6.4.2.1. The plan of action must address and reduce the failure by the next network assessment.
6.4.3. If the network failure remains at a mid-high or high level after the second assessment of network adequacy the Department will enact the provisions indicated in Section 18 of this contract.
6.4.4. If the network failure remains at the mid-high or high level after the third assessment of network adequacy the Department may enact additional measures including the network termination/transition process as outlined in the Managed Care Policy and Procedure Guide.
