Common use of Specialist and Ancillary Providers Clause in Contracts

Specialist and Ancillary Providers. The Contractor must provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. The providers are not limited to serve in only one (1) MCE network. In addition, physicians contracted as a PMP (if applicable) with one (1) MCE may contract as a specialist with other MCEs. The Contractor must ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. FSSA 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. FSSA requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor must provide, at a minimum, two (2) specialty providers within sixty (60) miles of the member’s residence. For providers identified with two (2) asterisks (**), the Contractor must provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence. THE REMAINDER OF THIS PAGE HAS DELIBERATELY BEEN LEFT BLANK EXHIBIT 1.M SCOPE OF WORK  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dermatologists**  Prosthetic suppliers**  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*  Oncologists*  Ophthalmologists*  Optometrists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physiatrists*  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists* FSSA requires that the Contractor maintain different network access standards for the listed ancillary providers as follows: • Two (2) durable medical equipment providers must be available to provide services to the Contractor’s members in each county or contiguous county; and • Two (2) home health providers must be available to provide services to the Contractor’s members in each county or contiguous county. The contractor must demonstrate the availability of providers with experience in serving wards and xxxxxx children. These providers should have expertise in caring for victims of child abuse and neglect, as well as the provision of trauma informed care, and should have training regarding the impact of trauma on effective assessment, treatment planning, EXHIBIT 1.M SCOPE OF WORK and integration of physical and behavioral health care and services. In addition, the Contractor must demonstrate the availability of providers with training, expertise and experience in providing smoking cessation services. Evidence that providers are trained to provide smoking cessation services must be available during FSSA’s monthly onsite visits. The Contractor must contract with the Indiana Hemophilia and Thrombosis Center or a similar FSSA-approved, federally recognized hemophilia treatment center. The Contractor must arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Providers. The Contractor must provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. The providers are not limited to serve in only one (1) MCE network. In addition, physicians contracted as a PMP (if applicable) with one (1) MCE may contract as a specialist with other MCEs. The Contractor must ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. FSSA 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. FSSA requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor must provide, at a minimum, two (2) specialty providers within sixty (60) miles of the member’s residence. For providers identified with two (2) asterisks (**), the Contractor must provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence. THE REMAINDER OF THIS PAGE HAS DELIBERATELY BEEN LEFT BLANK EXHIBIT 1.M SCOPE OF WORK  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dermatologists**  Prosthetic suppliers**  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*  Oncologists*  Ophthalmologists*  Optometrists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physiatrists*  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists* FSSA requires that the Contractor maintain different network access standards for the listed ancillary providers as follows: •  Two (2) durable medical equipment providers must be available to provide services to the Contractor’s members in each county or contiguous county; and •  Two (2) home health providers must be available to provide services to the Contractor’s members in each county or contiguous county. The contractor must demonstrate the availability of providers with experience in serving wards and xxxxxx children. These providers should have expertise in caring for victims of child abuse and neglect, as well as the provision of trauma informed care, and should have training regarding the impact of trauma on effective assessment, treatment planning, EXHIBIT 1.M SCOPE OF WORK and integration of physical and behavioral health care and services. In addition, the Contractor must demonstrate the availability of providers with training, expertise and experience in providing smoking cessation services. Evidence that providers are trained to provide smoking cessation services must be available during FSSA’s monthly onsite visits. The Contractor must contract with the Indiana Hemophilia and Thrombosis Center or a similar FSSA-approved, federally recognized hemophilia treatment center. The Contractor must arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Providers. The Contractor must provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. The providers are not limited to serve in only one (1) MCE network. In addition, physicians contracted as a PMP (if applicable) with one (1) MCE may contract as a specialist with other MCEs. The Contractor must ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. FSSA 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. FSSA requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor must provide, at a minimum, two (2) specialty providers within sixty (60) miles of the member’s residence. For providers identified with two (2) asterisks (**), the Contractor must provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence. THE REMAINDER OF THIS PAGE HAS DELIBERATELY BEEN LEFT BLANK EXHIBIT 1.M SCOPE OF WORK  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dermatologists**  Prosthetic suppliers**  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*  Oncologists*  Ophthalmologists*  Optometrists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physiatrists*  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists*  Diagnostic testing*  Durable Medical Equipment  Home Health  Prosthetic suppliers** FSSA requires that the Contractor maintain different network access standards for the listed ancillary providers as follows: •  Two (2) durable medical equipment providers must be available to provide services to the Contractor’s members in each county or contiguous county; and •  Two (2) home health providers must be available to provide services to the Contractor’s members in each county or contiguous county. The contractor must demonstrate the availability of providers with experience in serving wards and xxxxxx children. These providers should have expertise in caring for victims of child abuse and neglect, as well as the provision of trauma informed care, and should have training regarding the impact of trauma on effective assessment, treatment planning, EXHIBIT 1.M SCOPE OF WORK and integration of physical and behavioral health care and services. In addition, the Contractor must demonstrate the availability of providers with training, expertise and experience in providing smoking cessation services. Evidence that providers are trained to provide smoking cessation services must be available during FSSA’s monthly onsite visits. The Contractor must contract with the Indiana Hemophilia and Thrombosis Center or a similar FSSA-approved, federally recognized hemophilia treatment center. The Contractor must arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.

Specialist and Ancillary Providers. The Contractor must provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. The providers are not limited to serve in only one (1) MCE network. In addition, physicians contracted as a PMP (if applicable) with one (1) MCE may contract as a specialist with other MCEs. The Contractor must ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. FSSA 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. FSSA requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor must provide, at a minimum, two (2) specialty providers within sixty (60) miles of the member’s residence. For providers identified with two (2) asterisks (**), the Contractor must provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence. THE REMAINDER OF THIS PAGE HAS DELIBERATELY BEEN LEFT BLANK EXHIBIT 1.M SCOPE OF WORK  Anesthesiologists*  Diagnostic testing*  Cardiologists*  Durable Medical Equipment  Cardiothoracic surgeons**  Home Health  Dermatologists**  Prosthetic suppliers**  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*  Oncologists*  Ophthalmologists*  Optometrists*  Orthopedic surgeons*  Orthopedists  Otolaryngologists  Pathologists**  Physiatrists*  Physical therapists*  Psychiatrists*  Pulmonologists*  Radiation oncologists**  Rheumatologists**  Speech therapists*  Urologists*  Diagnostic testing*  Durable Medical Equipment  Home Health  Prosthetic suppliers** FSSA requires that the Contractor maintain different network access standards for the listed ancillary providers as follows: • Two (2) durable medical equipment providers must be available to provide services to the Contractor’s members in each county or contiguous county; and • Two (2) home health providers must be available to provide services to the Contractor’s members in each county or contiguous county. The contractor must demonstrate the availability of providers with experience in serving wards and xxxxxx children. These providers should have expertise in caring for victims of child abuse and neglect, as well as the provision of trauma informed care, and should have training regarding the impact of trauma on effective assessment, treatment planning, EXHIBIT 1.M SCOPE OF WORK and integration of physical and behavioral health care and services. In addition, the Contractor must demonstrate the availability of providers with training, expertise and experience in providing smoking cessation services. Evidence that providers are trained to provide smoking cessation services must be available during FSSA’s monthly onsite visits. The Contractor must contract with the Indiana Hemophilia and Thrombosis Center or a similar FSSA-approved, federally recognized hemophilia treatment center. The Contractor must arrange for laboratory services only through those IHCP enrolled laboratories with Clinical Laboratory Improvement Amendments (CLIA) certificates.