Adequacy of Providers. The Contractor shall maintain appropriate levels, as determined by SCDHHS, of organizational components, including, but not limited to, PCPs, specialty providers and other providers necessary for the provision of the services under this Contract. The Contractor shall establish and maintain provider networks and in-area referral providers in sufficient numbers, as determined by SCDHHS, to ensure that all contracted services are available and accessible in a timely manner within the Contractor's service area in accordance with §4 and as approved by SCDHHS. The Contractor shall make available and accessible, as determined by SCDHHS, hospitals, facilities, and professional personnel sufficient to provide the required core benefits. The locations of facilities, PCPs, and network providers must be sufficient in terms of geographic convenience to low-income and rural areas. SCDHHS’ detailed standards, criteria and requirements for county network submissions and ongoing review are located in the Policy and Procedure Guide. Services to a Program member shall be provided in the same manner as those services that are provided to commercial members of the Contractor. The Contractor shall notify SCDHHS immediately of any changes to the composition of its provider network and/or subcontractors that materially and adversely affects its ability to make available all core benefits in a timely manner in accordance with §4 of this Contract. The Contractor shall also have procedures to address changes in its provider network that negatively affect the ability of members to access services. Material changes in provider network composition that are not prior approved by SCDHHS and/or that may impair the member's access to services will be considered as grounds for Contract termination. The Contractor understands and agrees that notwithstanding the execution of this Contract, neither the Contractor nor its subcontractor/network provider shall provide any services until the Contractor has an adequate provider network verified and approved by SCDHHS. In the event any county network(s) is found to be in violation of requirements stated in §4.9.2, Adequacy of Providers, SCDHHS reserves the right to implement the Provider Network Termination and/or Transition Plan, as described in the Policy and Procedure Guide. The Contractor will be responsible for all financial costs associated with termination or transition of its provider network(s), including, but not limited to, costs associat...
Adequacy of Providers. The CCN shall maintain appropriate levels of primary care providers for the provision of services under this Provider Agreement to ensure adequate accessibility for CCN members. The CCN shall also make available and accessible, as determined by DHH, professional personnel sufficient to provide the required enhanced primary care case management services. The locations of primary care providers must be sufficient in terms of geographic convenience to Medicaid/CHIP enrollees.
