Proximity Access Requirements. 2.8.2.1. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards, as applicable:
2.8.2.1.1. For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxxx://xxx.xxx.xxx/Medicare-Medicaid- Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination- Office/FinancialAlignmentInitiative/MMPInformationandGuida nce/MMPApplicationandAnnualRequirements.html);
2.8.2.1.2. For Medicare pharmacy providers, time, distance and minimum number as required in Appendix F, Article II, Section I and 42 C.F.R. §423.120; and
2.8.2.1.3. For non-pharmacy Medicare medical providers and facilities: 2.
8.2.1.3.1. Primary Care Providers
2.8.2.1.3.1.1. Enrollees shall have a choice of at least two (2) PCPs within the applicable time and distance standards set forth in Section 2.8.2.1.1.
Proximity Access Requirements. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards, as applicable: For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxxx://xxx.xxx.xxx/Medicare‑Medicaid‑Coordination/Medicare‑and‑Medicaid‑Coordination/Medicare‑Medicaid‑Coordination‑Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPApplicationandAnnualRequirements.html); For Medicare pharmacy providers, time, distance and minimum number as required in Appendix F, Article II, Section I and 42 C.F.R. §423.120; and For non‑pharmacy Medicare medical providers and facilities: Primary Care Providers
Proximity Access Requirements. 2.7.9.1. The ICDS Plan must demonstrate annually that its Provider Network meets the stricter of the following standards:
2.7.9.1.1. For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxxx://xxx.xxx.xxx/Medicare-Medicaid-Coordination/Medicare-and- Medicaid-Coordination/Medicare-Medicaid-Coordination- Office/FinancialAlignmentInitiative/MMPInformationandGuidance/Inform ationandGuidanceforPlans.html);
2.7.9.1.2. For Medicare pharmacy providers, time, distance and minimum number as required in and 42 C.F.R. § 423.120.
2.7.9.2. Within the following State Specific Standards:
2.7.9.2.1. LTSS Providers-The ICDS Plan must contract with at least the minimum number of LTSS providers as required by ODM per Appendix H of the MyCare Ohio Provider Agreement and;
2.7.9.2.2. Adult Day Health/Assisted Living: Effective July 1, 2022, ninety percent (90%) of all members residing in a county must be within thirty
Proximity Access Requirements. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards: For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxx://xxx.xxx.xxx/Medicare/Medicare-Advantage/MedicareAdvantageApps/ index.html); For Medicare pharmacy providers, time, distance and minimum number as required in Appendix F, Article II, Section I and 42 C.F.R. §423.120; or Within a 15-mile or 30 minute radius from the Enrollee’s ZIP code of residence: At least two PCPs;
Proximity Access Requirements. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards: For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxx://xxx.xxx.xxx/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/InformationandGuidanceforPlans.html)); For Medicare pharmacy providers, time, distance and minimum number as required in Appendix F, Article II, Section I and 42 C.F.R. §423.120; or Within a 15-mile or 30 minute radius from the Enrollee’s ZIP code of residence: At least two PCPs;
Proximity Access Requirements. 2.9.2.1. The Contractor must demonstrate annually that its Provider Network meets the following standards:
2.9.2.1.1. For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxx://xxx.xxx.xxx/Medicare/Medicare- Advantage/MedicareAdvantageApps/index.html);
2.9.2.1.2. For Medicare pharmacy providers, time, distance and minimum number as required in Appendix E, Article II, Section I and 42 C.F.R. §423.120;
2.9.2.1.3. For services for which Medicaid is the traditional primary payer (including LTSS and community mental health and substance abuse services), each Enrollee shall have a choice of at least two
Proximity Access Requirements. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards:
1. For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxx://xxx.xxx.xxx/Medicare/Medicare- Advantage/MedicareAdvantageApps/ index.html);
2. For Medicare pharmacy providers, time, distance and minimum number as required in Appendix F, Article II, Section I and 42 C.F.R. §423.120; or
3. Within a 15-mile or 30 minute radius from the Enrollee’s ZIP code of residence:
a. At least two PCPs;
b. Two hospitals (when feasible); and
c. Two nursing facilities, except that with CMS and EOHHS prior approval, Contractor may offer Enrollee only one nursing facility.
4. In addition, the Contractor must demonstrate annually that its Provider Network has sufficient providers to ensure that each Enrollee has a choice of at least two outpatient Behavioral Health Providers and two community LTSS Providers per Covered Service as listed in Appendix A that are either within a 15-mile radius or 30 minutes from the Enrollee’s ZIP code of residence, except that with EOHHS prior approval, Contractor may offer Enrollee only one community LTSS Provider per Covered Service.
Proximity Access Requirements. 2.7.9.1. The ICDS Plan must demonstrate annually that its Provider Network meets the stricter of the following standards:
2.7.9.1.1. For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxx://xxx.xxx.xxx/Medicare/Medicare- Advantage/MedicareAdvantageApps/ index.html);
2.7.9.1.2. For Medicare pharmacy providers, time, distance and minimum number as required in and 42 C.F.R. § 423.120 2.7.9.2. Within the following State Specific Standards:
2.7.9.2.1. LTSS Providers:
2.7.9.2.1.1. At least two (2) community LTSS Providers in each region for the following services: enhanced community living, homemaker, waiver transportation, nutritional consultation, social work counseling, out of home respite, home medical equipment and supplemental adaptive and assistive devices, independent living assistance and community transition.
2.7.9.2.1.2. At least one (1) community LTSS Provider in each region for the following services: pest control, home delivered meals, emergency response, home modifications maintenance and repairs, and chore services.
2.7.9.2.2. Adult Day Health/Assisted Living: At least one (1) adult day health and one (1) assisted living provider within thirty (30) miles of each zip code within the region.
Proximity Access Requirements. For Medicare pharmacy providers, the Contractor shall adhere to the time, distance and minimum number as required in 42 C.F.R. §423.120; and For all non-pharmacy providers, the Contractor shall demonstrate annually that its Provider Network meets the stricter of the following standards, as applicable: Adhere to CMS’s most current Medicare Advantage network adequacy criteria, including time and distance standards, that apply to the Contractor’s service area; and EOHHS standards specified below: Enrollees shall have a choice of at least two (2) PCPs within the applicable time and distance standards; Enrollees shall have a choice of two (2) hospitals within the applicable Medicare Advantage time and distance standards, except that if only one (1) hospital is located within a County, the second hospital may be within a fifty (50) mile radius of the Enrollee’s ZIP code of residence; and Enrollees shall have a choice of two (2) nursing facilities within the applicable Medicare Advantage time and distance standards, except that if only one (1) nursing facility is located within a County, the second nursing facility may be within a fifty (50) mile radius of the Enrollee’s ZIP code of residence. If admission to a nursing facility is medically necessary because an Enrollee cannot be safely supported in the community, Enrollees shall be admitted to a nursing facility within five (5) business days from the date the Enrollee is eligible to be discharged from a hospital. The Contractor shall demonstrate annually that its Provider Network has sufficient providers to ensure that each Enrollee has a choice of at least two (2) outpatient and diversionary Behavioral Health Providers and two (2) community LTSS providers per Covered Service as referenced in Section 2.7 and defined in Appendix C that are either within a fifteen (15) mile radius or thirty (30) minutes from the Enrollee’s ZIP code of residence, except that with EOHHS prior approval, Contractor may offer Enrollee only one community LTSS provider per Covered Service. At least 90% of Enrollees in each of the Contractor’s Service Areas shall have access to Providers in accordance with the time and distance standards specified in Section 2.10.4. If no time or distance is indicated, the Contractor shall have at least two Providers located anywhere in the Commonwealth. EOHHS reserves the right to update these standards; and In determining compliance with the time and distance standards, the Contractor shall take into ac...
Proximity Access Requirements. 2.9.2.1. The Contractor must demonstrate annually that its Provider Network meets the following standards:
2.9.2.1.1. For Medicare medical providers and facilities, time, distance and minimum number standards updated annually on the CMS website (xxxx://xxx.xxx.xxx/Medicare-Medicaid- Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination- Office/FinancialAlignmentInitiative/InformationandGuidanc eforPlans.html);
2.9.2.1.2. For Medicare pharmacy providers, time, distance and minimum number as required in Appendix E, Article II, Section I and 42 C.F.R. §423.120;
2.9.2.1.3. For services for which Medicaid is the traditional primary payer (including LTSS and community mental health and substance abuse services), each Enrollee shall have a choice of at least two (2) providers of each service type located within no more than thirty (30) minutes travel time from any Enrollee in urban areas unless the Contractor has a DMAS- approved alternative time standard. Travel time shall be determined based on driving during normal traffic conditions. The Contractor shall ensure that each Enrollee shall have a choice of at least two (2) providers of each service type located within no more than sixty (60) minutes travel time from any Enrollee in rural areas unless the Contractor has a DMAS approved alternative time
2.9.2.1.4. For providers of overlap services that may be subject to either Medicaid or Medicare network requirements, the stricter of any applicable standards will apply.
