Proximity Access Standards. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards:
2.8.2.1 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);
2.8.2.2 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; or 2.8.2.3 Within the following State Specific Standards:
Proximity Access Standards. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards:
Proximity Access Standards. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards:
2.8.2.1 For Medicare medical Providers and facilities, time, distance and minimum number standards updated annually on the CMS website (MMP Reference File );
2.8.2.2 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; or
2.8.2.3 Within the following State Specific Standards:
2.8.2.3.1 NF and Supportive Living Facility (SLF) Standards. The Contractor is required to offer contracts to all NFs and SLFs in the Service Area that render such Covered Services so long as such Provider meets all applicable State and federal requirements for participation in the Medicaid Program and meets the qualifications of the applicable HCBS Waiver. For NF services covered under the traditional Medicaid benefit, the contract offered by the Contractor to the NFs and SLF must provide for payment that equates to at least the Medicaid payment level in Illinois FFS Medicaid. Nothing in this provision shall preclude Contractor and NFs or SLF from agreeing to alternate payment arrangements.
2.8.2.3.1.1 For NFs, the Contractor shall ensure that at least two (2) NFs are within a fifteen (15) mile or thirty (30) minute radius from the Enrollee’s ZIP code of residence within each county of the Service Area, provided that each NF meets all applicable State and federal requirements for participation in the Medicaid and Medicare Programs. Notwithstanding the foregoing, the Contractor may offer an Enrollee only one NF with the Prior Approval of CMS and the Department.
Proximity Access Standards. The FIDA-IDD Plan must have a Provider Network that is geographically accessible to Participants in the Service Area.
Proximity Access Standards. The Contractor must demonstrate annually that its Provider Network meets the stricter of the following standards:
2.8.2.1 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/InformationandGuidanceforPlans.html );
2.8.2.2 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; or
2.8.2.3 Within the following State Specific Standards:
2.8.2.3.1 NF and Supportive Living Facility Standards. Unless the Department approves an exception, for the first twelve months of the Demonstration (February 1, 2014 – January 31, 2015), the Contractor is required to offer contracts to all NFs and Supportive Living Facilities (SLFs) in the service area that render such Covered Services so long as such Provider meets all applicable State and federal requirements for participation in the Medicaid Program and meets the qualifications of the applicable HCBS waiver. For NF services covered under the traditional Medicaid benefit, the contract offered by the Contractor to the NFs and SLF must provide for payment that equates to at least the Medicaid payment level in Illinois FFS Medicaid. Nothing in this provision shall preclude Contractor and NFs or SLF from agreeing to alternate payment arrangements.
2.8.2.3.1.1 For NFs, the Contractor shall ensure that at least two NFs are within a fifteen (15)mile or thirty (30) minute radius from the Enrollee’s ZIP code of residence within each county of the Service Area, provided that each NF meets all applicable State and federal requirements for participation in the Medicaid and Medicare Programs. Notwithstanding the foregoing, the Contractor may offer an Enrollee only one NF with the Prior Approval of CMS and the Department.
