Common use of Availability and Access Standards Clause in Contracts

Availability and Access Standards. This network must include a panel of primary care providers from which the enrollee may select a personal primary care provider. Requirements for adequate access state that: • Routinely used delivery sites, including PCPs’ offices and the offices of frequently used specialists, must be located within thirty (30) minutes travel time, including but not limited to: pediatric primary care, OB/GYN, pediatric mental health providers, pediatric Substance Use Disorder (SUD) providers, pediatric specialists, pediatric dental; • Basic hospital services must be located within forty-five (45) minutes travel time; and • Tertiary services must be located within sixty (60) minutes travel time. The intent of these standards is to provide for access to services at least as good, if not better, than access to care under the traditional Medicaid program. DHHR will periodically publish specific network standards that define which provider types are considered “frequently used specialists” in each county or region, based on a comparison to the traditional Medicaid program or other criteria as defined by DHHR. Exceptions to these standards will be permitted where the travel time standard is better than what exists in the community at large. For example if the community standard for basic hospital services is sixty (60) minutes travel time, then the MCO’s basic hospital service must be located within sixty (60) minutes travel time (not within forty-five

Availability and Access Standards. This network must include a panel of primary care providers from which the enrollee may select a personal primary care provider. Requirements for adequate access state that: •  Routinely used delivery sites, including PCPs’ offices and the offices of frequently used specialists, must be located within thirty (30) minutes travel time, including but not limited to: pediatric primary care, OB/GYN, pediatric mental health providers, pediatric Substance Use Disorder (SUD) providers, pediatric specialists, pediatric dental; •  Basic hospital services must be located within forty-five (45) minutes travel time; and •  Tertiary services must be located within sixty (60) minutes travel time. The intent of these standards is to provide for access to services at least as good, if not better, than access to care under the traditional Medicaid program. DHHR will periodically publish specific network standards that define which provider types are considered “frequently used specialists” in each county or region, based on a comparison to the traditional Medicaid program or other criteria as defined by DHHR. Exceptions to these standards will be permitted where the travel time standard is better than what exists in the community at large. For example if the community standard for basic hospital services is sixty (60) minutes travel time, then the MCO’s basic hospital service must be located within sixty (60) minutes travel time (not within forty-five