Common use of FEDERAL ACCESS STANDARDS Clause in Contracts

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure that they are in compliance with the following federally defined Provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  The anticipated Medicaid membership.  The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFS, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM), in a format specified by ODM, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM no less frequently than at the time the MCP enters into a contract with ODM; at any time there is a significant change (as defined by ODM) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. North East Region - Hospitals Minimum Provider Panel Requirements Total Required Hospitals Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required Hospitals: Out-of-Region Hospital System 1 1 1 These hospitals must provide obstetrical services if such a hospital is available in the county/region.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Appendix H Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website, in order to comply with these federal access requirements. North East Region - Hospitals Minimum Provider Panel Requirements Total Required Hospitals Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required Hospitals: In-Region

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. WellCare APPENDIX J FINANCIAL PERFORMANCE CFC ELIGIBLE POPULATION

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. APPENDIX K QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT PROGRAM AND EXTERNAL QUALITY REVIEW ABD ELIGIBLE POPULATION 1. As required by federal regulation, 42 CFR 438.240, each managed care plan (MCP) must have an ongoing Quality Assessment and Performance Improvement Program (QAPI) that is annually prior-approved by the Ohio Department of Job and Family Services (ODJFS). The program must include the following elements:

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website, in order to comply with these federal access requirements. North East Region - Hospitals Minimum Provider Panel Requirements Total Required Hospitals Ashtabula Cuyahoga Erie Geauga Huron Lake Lxxxxx Xxxxxx Additional Required Hospitals: Out-of-Region Hospital System1 1 1 1 1 Hospital system includes; physician networks and therefore these physicians could be considered when fulfilling contracts for PCP and non-PCP provider panel requirements North East Region - PCP Capacity Minimum PCP Capacity Requirements - ABD PCPs Total Required Ashtabula Cuyahoga Erie Geauga Huron Lake Lxxxxx Xxxxxx Additional Required: In-Region * Capacity 9,981 585 7,370 213 85 173 385 990 180 Number of Eligibles 25,810 1462 18425 532 213 432 963 2474 451 1 Acceptable PCP specialty types include Family/General Practice or Internal Medicine North East Region - Practitioners ABD Provider Panel Requirements Provider Types Total Required Providers1 Ashtabula Cuyahoga Erie Geauga Huron Lake Lxxxxx Xxxxxx Additional Required Providers2 Gastroenterology 3 2 1 Nephrology 2 1 1 Neurology 3 2 1 Otolaryngologist 3 1 1 1 Physical Med Rehab 3 2 1 Psychiatry 11 5 3 3 Urology 4 2 2 1 All required providers must be located within the region. 2 Additional required providers may be located anywhere within the region APPENDIX I PROGRAM INTEGRITY ABD ELIGIBLE POPULATION MCPs must comply with all applicable program integrity requirements, including those specified in 42 CFR 455 and 42 CFR 438 Subpart H.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver furnish the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting panel providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with these timely access requirements, . MCPs are required to regularly monitor their provider panels to determine compliance and must if necessary take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 437.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual in order to comply with these federal access requirements. Appendix H

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s 's contracted provider panel is unable to provide the services covered under the MCP’s 's provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, . 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s 's operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website. in order to comply with these federal access requirements. North East Region - Hospitals Minimum Provider Panel Requirements Total Required Hospitals Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required Hospitals: Out-of-Region Hospital System 1 1 1 Preferred Providers are the additional provider contracts that must be secured in order for the MCP to receive bonus points. 2 These hospitals cannot be included under any subcontract used to meet the minimim required provider panel requirements. 3 These hospitals must provide obstetrical services if such a hospital is available in the county/region. 4 The Cuyahoga hospital requirement may be met by either contracting with (1) a single hospital system that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds OR (2) a single general hospital that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds and a hospital system.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. Appendix H MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website, in order to comply with these federal access requirements. North East Region - Hospitals Minimum Provider Panel Requirements Total Required Hospitals Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required Hospitals: Out-of- Region Hospital System 1 1 1 Preferred Providers are the additional provider contracts that must be secured in order for the MCP to receive bonus points. 2 These hospitals cannot be included under any subcontract used to meet the minimum required provider panel requirements. 3 These hospitals must provide obstetrical services if such a hospital is available in the county/region. 4 The Cuyahoga hospital requirement may be met by either contracting with (1) a single hospital system that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds OR (2) a single general hospital that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds and a hospital system. As of November 20, 2006 North East Central Region - Hospitals Minimum Provider Panel Requirements Total Required Hospitals Columbiana Mahoning Trumbull Additional Required Hospitals: Out-of-Region General Hospital3 3 1 1 4 1 Hospital System 1 Preferred Providers are the additional provider contracts that must be secured in order for the MCP to receive bonus points. 2 These hospitals cannot be included under any subcontract used to meet the minimum required provider panel requirements. 3 These hospitals must provide obstetrical services if such a hospital is available in the county/region, except where a hospital must meet the criteria specified in footnote #4 below.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  - The anticipated Medicaid membership.  - The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  - The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  - The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  - MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s 's contracted provider panel is unable to provide the services covered under the MCP’s 's provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s 's operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website, in order to comply with these federal access requirements. NORTH EAST REGION - HOSPITALS MINIMUM PROVIDER PANEL REQUIREMENTS

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, . MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver furnish the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if Appendix H the MCP’s 's contracted provider panel is unable to provide the services covered under the MCP’s 's provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with w ith the applicable requirements. Contracting panel providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, . when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with w'ith these timely access requirements, . MCPs are required to regularly monitor their provider panels to determine compliance and must if necessary take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODM, OD.IFS. that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, . and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s 's operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual in order to comply with these federal access requirements. North East Region - Hospitals Minimum Provider Panel Requirements Preferred Providers 1 Total Required Hospitals Ashtabula Cuyahoga Erie Geauga Huron Lake Xxxxxx Xxxxxx Additional Required Hospitals: Out-of-Region Preferred Hospitals: In-Region2 Preferred Hospitals: Out-of Region 1 Preferred Providers are the additional provider contracts that must be secured in order for the MCP to receive bonus points. 2 These hospitals cannot be included under any subcontract used to meet the minimum required provider panel requirements. 3 These hospitals must provide obstetrical services if such a hospital is available in the county/region. 4 The Cuyahoga hospital requirement may be met by either contracting with (1) a single hospital that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds OR (2) a single general hospital that includes fifty (50) pediatric beds and five (5) pediatric intensive care unit (PICU) beds and a hospital system. NORTHEAST REGION

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  - The anticipated Medicaid membership.  - The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  - The number and types (in terms of training, experience, and specialization) of panel providers required to deliver furnish the contracted Medicaid services.  - The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  - MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s 's contracted provider panel is unable to provide the services covered under the MCP’s 's provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting panel providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with these timely access requirements, . MCPs are required to regularly monitor their provider panels to determine compliance and must if necessary take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 437.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s 's operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual in order to comply with these federal access requirements.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s 's contracted provider panel is unable to provide the services covered under the MCP’s 's provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Appendix H Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s 's operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual, posted on the ODJFS website. in order to comply with these federal access requirements.

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with timely access requirements, and must take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP.. Molina APPENDIX J FINANCIAL PERFORMANCE CFC ELIGIBLE POPULATION

FEDERAL ACCESS STANDARDS. MCPs must provide or arrange for the delivery of all medically necessary, Medicaid-covered health services, as well as assure demonstrate that they are in compliance with the following federally defined Provider provider panel access standards as required by 42 CFR 438.206: In establishing and maintaining their provider panel, MCPs must consider the following:  • The anticipated Medicaid membership.  • The expected utilization of services, taking into consideration the characteristics and health care needs of specific Medicaid populations represented in the MCP.  • The number and types (in terms of training, experience, and specialization) of panel providers required to deliver furnish the contracted Medicaid services.  • The geographic location of panel providers and Medicaid members, considering distance, travel time, the means of transportation ordinarily used by Medicaid members, and whether the location provides physical access for Medicaid members with disabilities.  • MCPs must adequately and timely cover services to an out-of-network provider if the MCP’s contracted provider panel is unable to provide the services covered under the MCP’s provider agreement. The MCP must cover the out-of-network services for as long as the MCP network is unable to provide the services. MCPs must coordinate with the out-of-network provider with respect to payment and ensure that the provider agrees with the applicable requirements. Contracting panel providers must offer hours of operation that are no less than the hours of operation offered to commercial members or comparable to Medicaid FFSfee-for-service, if the provider serves only Medicaid members. MCPs must ensure that services are available 24 hours a day, 7 days a week, when medically necessary. MCPs must establish mechanisms to ensure that panel providers comply with these timely access requirements, . MCPs are required to regularly monitor their provider panels to determine compliance and must if necessary take corrective action if there is failure to comply. In order to demonstrate adequate provider panel capacity and services, 42 CFR 438.206 and 438.207 437.207 stipulates that the MCP must submit documentation to the Ohio Department of Medicaid (ODM)ODJFS, in a format specified by ODMODJFS, that demonstrates it offers an appropriate range of preventive, primary care and specialty services adequate for the anticipated number of members in the service area, while maintaining a provider panel that is sufficient in number, mix, and geographic distribution to meet the needs of the number of members in the service area. This documentation of assurance of adequate capacity and services must be submitted to ODM ODJFS no less frequently than at the time the MCP enters into a contract with ODMODJFS; at any time there is a significant change (as defined by ODMODJFS) in the MCP’s operations that would affect adequate capacity and services (including changes in services, benefits, geographic service or payments); and at any time there is enrollment of a new population in the MCP. MCPs are to follow the procedures specified in the current MCP PVS Instructional Manual in order to comply with these federal access requirements.