Common use of Specialist and Ancillary Provider Network Requirements Clause in Contracts

Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for each specialty type within sixty (60) miles of the member’s residence. For providers identified with two asterisks (**), the Contractor shall provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence.  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dentists/Oral Surgeons *  Prosthetic suppliers**  Dermatologists**  Endocrinologists*  Gastroenterologists*  General surgeons*  Hematologists  Infectious disease specialists**  Interventional radiologists**  Nephrologists*  Neurologists*  Neurosurgeons**  Non-hospital based anesthesiologist (e.g., pain medicine)**  OB/GYNs  Occupational therapists*  Occupational therapists*  Oncologists*  Ophthalmologists*  Optometrists*  Orthodontists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists* OMPP requires that the Contractor maintain network access standards for the listed ancillary providers as follows:  Two (2) durable medical equipment providers shall be available to provide services to the Contractor’s members in each county or contiguous county; and  Two (2) home health providers shall be available to provide services to the Contractor’s members in each county or contiguous county. In addition, the Contractor shall demonstrate the availability of providers with training, expertise and experience in providing tobacco dependence treatment services, especially to pregnant women. Evidence that providers are trained to provide tobacco dependence treatment services must be available during OMPP’s monthly onsite visits. The Contractor shall contract with the Indiana Hemophilia and Thrombosis Center or a similar OMPP-approved, federally recognized hemophilia treatment center. This requirement is based on the findings of the Centers for Disease Control and Prevention (CDC) which illustrate that persons affected by a bleeding disorder receiving treatment from a federally recognized treatment center require fewer hospitalizations, experience less bleeding episodes and experience a forty percent (40%) reduction in morbidity and mortality. The Contractor shall arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for each specialty type within sixty (60) miles of the member’s residence. For providers identified with two asterisks (**), the Contractor shall provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence.  Specialties Ancillary Providers ⮚ Anesthesiologists*  Diagnostic testing*  ⮚ Cardiologists*  Durable Medical Equipment  ⮚ Cardiothoracic surgeons**  Home Health  ⮚ Dentists/Oral Surgeons *  Prosthetic suppliers**  ⮚ Dermatologists**  ⮚ Endocrinologists*  ⮚ Gastroenterologists*  ⮚ General surgeons*  ⮚ Hematologists  ⮚ Infectious disease specialists**  ⮚ Interventional radiologists**  ⮚ Nephrologists*  ⮚ Neurologists*  ⮚ Neurosurgeons**  ⮚ Non-hospital based anesthesiologist (e.g., pain medicine)**  ⮚ OB/GYNs  ⮚ Occupational therapists*  ⮚ Occupational therapists*  ⮚ Oncologists*  ⮚ Ophthalmologists*  Optometrists⮚ Diagnostic testing*  Orthodontists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists⮚ Durable Medical Equipment ⮚ Home Health ⮚ Prosthetic suppliers**  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists* OMPP requires that the Contractor maintain network access standards for the listed ancillary providers as follows:  Two (2) durable medical equipment providers shall be available to provide services to the Contractor’s members in each county or contiguous county; and  Two (2) home health providers shall be available to provide services to the Contractor’s members in each county or contiguous county. In addition, the Contractor shall demonstrate the availability of providers with training, expertise and experience in providing tobacco dependence treatment services, especially to pregnant women. Evidence that providers are trained to provide tobacco dependence treatment services must be available during OMPP’s monthly onsite visits. The Contractor shall contract with the Indiana Hemophilia and Thrombosis Center or a similar OMPP-approved, federally recognized hemophilia treatment center. This requirement is based on the findings of the Centers for Disease Control and Prevention (CDC) which illustrate that persons affected by a bleeding disorder receiving treatment from a federally recognized treatment center require fewer hospitalizations, experience less bleeding episodes and experience a forty percent (40%) reduction in morbidity and mortality. The Contractor shall arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for each specialty type within sixty (60) miles of the member’s residence. For providers identified with two asterisks (**), the Contractor shall provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence.  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dentists/Oral Surgeons *  Prosthetic suppliers**  Dermatologists**  Endocrinologists*  Gastroenterologists*  General surgeons*  Hematologists  Infectious disease specialists**  Interventional radiologists**  Nephrologists*  Neurologists*  Neurosurgeons**  Non-hospital based  Diagnostic testing*  Durable Medical Equipment  Home Health  Prosthetic suppliers** anesthesiologist (e.g., pain medicine)**  OB/GYNs  Occupational therapists*  Occupational therapists*  Oncologists*  Ophthalmologists*  Optometrists*  Orthodontists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists* OMPP requires that the Contractor maintain network access standards for the listed ancillary providers as follows:  Two (2) durable medical equipment providers shall be available to provide services to the Contractor’s members in each county or contiguous county; and  Two (2) home health providers shall be available to provide services to the Contractor’s members in each county or contiguous county. In addition, the Contractor shall demonstrate the availability of providers with training, expertise and experience in providing tobacco dependence treatment services, especially to pregnant women. Evidence that providers are trained to provide tobacco dependence treatment services must be available during OMPP’s monthly onsite visits. The Contractor shall contract with the Indiana Hemophilia and Thrombosis Center or a similar OMPP-approved, federally recognized hemophilia treatment center. This requirement is based on the findings of the Centers for Disease Control and Prevention (CDC) which illustrate that persons affected by a bleeding disorder receiving treatment from a federally recognized treatment center require fewer hospitalizations, experience less bleeding episodes and experience a forty percent (40%) reduction in morbidity and mortality. The Contractor shall arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for each specialty type within sixty (60) miles of the member’s residence. For providers identified with two asterisks (**), the Contractor shall provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence.  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dentists/Oral Surgeons *  Prosthetic suppliers**  Dermatologists**  Endocrinologists*  Gastroenterologists*  General surgeons*  Hematologists  Infectious disease specialists**  Interventional radiologists**  Nephrologists*  Neurologists*  Neurosurgeons**  Non-hospital based anesthesiologist (e.g., pain medicine)**  OB/GYNs  Occupational therapists*  Occupational therapists*  Oncologists*  Ophthalmologists*  Optometrists*  Orthodontists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists*  Diagnostic testing*   Durable Medical Equipment   Home Health   Prosthetic suppliers**                              OMPP requires that the Contractor maintain network access standards for the listed ancillary providers as follows:   Two (2) durable medical equipment providers shall be available to provide services to the Contractor’s members in each county or contiguous county; and   Two (2) home health providers shall be available to provide services to the Contractor’s members in each county or contiguous county. In addition, the Contractor shall demonstrate the availability of providers with training, expertise and experience in providing tobacco dependence treatment services, especially to pregnant women. Evidence that providers are trained to provide tobacco dependence treatment services must be available during OMPP’s monthly onsite visits. The Contractor shall contract with the Indiana Hemophilia and Thrombosis Center or a similar OMPP-approved, federally recognized hemophilia treatment center. This requirement is based on the findings of the Centers for Disease Control and Prevention (CDC) which illustrate that persons affected by a bleeding disorder receiving treatment from a federally recognized treatment center require fewer hospitalizations, experience less bleeding episodes and experience a forty percent (40%) reduction in morbidity and mortality. The Contractor shall arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for each specialty type within sixty (60) miles of the member’s residence. For providers identified with two asterisks (**), the Contractor shall provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence.  ⮚ Anesthesiologists*  Diagnostic testing*  ⮚ Cardiologists*  Durable Medical Equipment  ⮚ Cardiothoracic surgeons**  Home Health  ⮚ Dentists/Oral Surgeons *  Prosthetic suppliers**  ⮚ Dermatologists**  ⮚ Endocrinologists*  ⮚ Gastroenterologists*  ⮚ General surgeons*  ⮚ Hematologists  ⮚ Infectious disease specialists**  ⮚ Interventional radiologists**  ⮚ Nephrologists*  ⮚ Neurologists*  ⮚ Neurosurgeons**  ⮚ Non-hospital based anesthesiologist (e.g., pain medicine)**  ⮚ OB/GYNs  ⮚ Occupational therapists*  ⮚ Occupational therapists*  ⮚ Oncologists*  ⮚ Diagnostic testing* ⮚ Durable Medical Equipment ⮚ Home Health ⮚ Prosthetic suppliers** ⮚ Ophthalmologists*  ⮚ Optometrists*  ⮚ Orthodontists*  ⮚ Orthopedic surgeons*  ⮚ Orthopedists  ⮚ Otolaryngologists  ⮚ Pathologists**  ⮚ Physical therapists*  ⮚ Psychiatrists*  ⮚ Pulmonologists*  ⮚ Radiation oncologists**  ⮚ Rheumatologists**  ⮚ Speech therapists*  ⮚ Urologists* OMPP requires that the Contractor maintain network access standards for the listed ancillary providers as follows:  ▪ Two (2) durable medical equipment providers shall be available to provide services to the Contractor’s members in each county or contiguous county; and  ▪ Two (2) home health providers shall be available to provide services to the Contractor’s members in each county or contiguous county. In addition, the Contractor shall demonstrate the availability of providers with training, expertise and experience in providing tobacco dependence treatment services, especially to pregnant women. Evidence that providers are trained to provide tobacco dependence treatment services must be available during OMPP’s monthly onsite visits. The Contractor shall contract with the Indiana Hemophilia and Thrombosis Center or a similar OMPP-approved, federally recognized hemophilia treatment center. This requirement is based on the findings of the Centers for Disease Control and Prevention (CDC) which illustrate that persons affected by a bleeding disorder receiving treatment from a federally recognized treatment center require fewer hospitalizations, experience less bleeding episodes and experience a forty percent (40%) reduction in morbidity and mortality. The Contractor shall arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for of each specialty type within sixty (60) miles of the member’s residence. For providers identified with two asterisks (**), the Contractor shall provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence.  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dentists/Oral Surgeons *  Prosthetic suppliers**  Dermatologists**  Endocrinologists*  Gastroenterologists*  General surgeons*  Hematologists  Infectious disease specialists**  Interventional radiologists**  Nephrologists*  Neurologists*  Neurosurgeons**  Non-hospital based anesthesiologist (e.g., pain medicine)**  OB/GYNs  Occupational therapists*  Occupational therapists*  Oncologists*  Ophthalmologists*  Optometrists*  Orthodontists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists* OMPP requires that the Contractor maintain different network access standards for the listed ancillary providers as follows:   Two (2) durable medical equipment providers shall be available to provide services to the Contractor’s members in each county or contiguous county; and   Two (2) home health providers shall be available to provide services to the Contractor’s members in each county or contiguous county. In addition, the Contractor shall demonstrate the availability of providers with training, expertise and experience in providing tobacco dependence treatment services, especially to pregnant women. Evidence that providers are trained to provide tobacco dependence treatment services must shall be available during OMPP’s monthly onsite visits. The Contractor shall contract with the Indiana Hemophilia and Thrombosis Center or a similar OMPP-approved, federally recognized hemophilia treatment center. This requirement is based on the findings of the Centers for Disease Control and Prevention (CDC) which illustrate that persons affected by a bleeding disorder receiving treatment from a federally recognized treatment center require fewer hospitalizations, experience less bleeding episodes and experience a forty percent (40%) reduction in morbidity and mortality. The Contractor shall arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.