Exceptions to Network Standards. BMS will consider requests for exceptions to the provider access standards under limited circumstances (e.g., if no appropriate provider types are located within the mileage standards) and may, in its sole discretion, grant exceptions to these standards. Each exception request from the MCO to BMS must be in writing and supported by information and documentation from the MCO. Exceptions to network requirements will be considered based on the information provided, current patterns of care, and locations where the travel time and distance standards differ significantly from providers in the community. The State will grant exceptions to MCOs based on additional documentation from the MCO that a provider may be seen out-of-network in the event a contracted provider arrangement cannot be obtained. Exceptions are monitored closely and typically only granted in instances where a provider does not exist within a specific geographic location and one in an urban area must be 7 Tertiary hospital services include (1) acute care services to pediatric patients in medical and surgical units; (2) obstetrics services; and (3) a neo-natal intensive care unit. leveraged; these exceptions will be applied consistently across all MCOs. The State will provide each MCO with all other MCO provider files to identify potential providers in service gap areas to help address any potential deficiencies to avoid the exemption process.
Exceptions to Network Standards. BMS will consider requests for exceptions to the provider access standards under limited circumstances (e.g., if no appropriate provider types are located within the mileage standards) and may, in its sole discretion, grant exceptions to these standards. Each exception request from the MCO to BMS must be in writing and supported by information and documentation from the MCO. Exceptions to network requirements will be considered based on the information provided, current patterns of care, and locations where the travel time and distance standards differ significantly from providers in the community. The State will grant exceptions to MCOs based on additional documentation from the MCO that a provider may be seen out-of-network in the event a contracted provider arrangement cannot be obtained. Exceptions are monitored closely and typically only granted in instances where a provider does not exist within a specific geographic location and one in an urban area must be leveraged; these exceptions will be applied consistently across all MCOs. The State will provide each MCO with all other MCO provider files to identify potential providers in service gap areas to help address any potential deficiencies to avoid the exemption process.
Exceptions to Network Standards. The Department will consider requests for exceptions to the provider access standards under limited circumstances (e.g. if no appropriate provider types are located within the mileage standards) and may, in its sole discretion, grant exceptions to these standards. Each exception request from the MCO to the Department must be in writing and supported by information and documentation from the MCO. Exceptions to network requirements will be considered based on the information provided, current patterns of care, and locations where the travel time and distance standards differ significantly from providers in the community.
Exceptions to Network Standards. BMS will consider requests for exceptions to the provider access standards under limited circumstances (e.g. if no appropriate provider types are located within the mileage standards) and may, in its sole discretion, grant exceptions to these standards. Each exception request from the MCO to BMS must be in writing and supported by information and documentation from the MCO. Exceptions to network requirements will be considered based on the information provided, current patterns of care, and locations where the travel time and distance standards differ significantly from providers in the community, as allowed in West Virginia’s 1915(b) Waiver.
