Common use of Network Capable of Full Array of Services Clause in Contracts

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglect. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract at the following times: • When the MCO enters into a Contract with DHHR; • On an annual basis; • When there has been a significant change in MCO operations; • When services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHR) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: • Anticipated enrollment under this Contract; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific populations covered by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all contracted services; • Numbers of network providers who are not accepting new patients; and • Geographic location of providers and enrollees, considering distance, travel time, the means of transportation ordinarily used by these enrollees, and whether the location provides physical access for enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 2 contracts

Samples: dhhr.wv.gov, dhhr.wv.gov

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Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglectstandards. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract contract, at the following times: • When time the MCO enters into a Contract contract with DHHRBMS; • On an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: • Anticipated enrollment under this ContractMedicaid enrollment; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; • Numbers of network providers who are not accepting new Medicaid patients; and • Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 2 contracts

Samples: Purchase of Service Provider Agreement, Purchase of Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglectstandards. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract contract, at the following times: • When time the MCO enters into a Contract contract with DHHRBMS; • On an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: Anticipated enrollment under this ContractMedicaid enrollment; Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; Numbers of network providers who are not accepting new Medicaid patients; and Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 2 contracts

Samples: Purchase of Service Provider Agreement, Purchase of Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract Contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglect. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract Contract, at the following times: • When time the MCO enters into a Contract with DHHRBMS; • On on an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: • Anticipated enrollment under this ContractMedicaid enrollment; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; • Numbers of network providers who are not accepting new Medicaid patients; and • Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 2 contracts

Samples: Service Provider Agreement, Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, personal care and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglectstandards. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract contract, at the following times: • When time the MCO enters into a Contract contract with DHHRBMS; • On an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: Anticipated enrollment under this ContractMedicaid enrollment; Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; Numbers of network providers who are not accepting new Medicaid patients; and Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 1 contract

Samples: Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglect. The MCO must submit to the Department BMS written documentation of the adequacy of its provider network as set forth in this Contract at the following times: • When the MCO enters into a Contract with DHHRBMS; • On an annual basis; • When there has been a significant change in MCO operations; • When services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: • Anticipated enrollment under this ContractMedicaid enrollment; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; • Numbers of network providers who are not accepting new Medicaid patients; and • Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHRBMS, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 1 contract

Samples: Model Purchase of Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contractin a timely manner. The MCO must shall maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglectstandards. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract contract, at the following times: • When time the MCO enters into a Contract contract with DHHRBMS; • On an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must shall consider the following: • Anticipated enrollment under this ContractMedicaid enrollment; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; • Numbers of network providers who are not accepting new Medicaid patients; and • Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 1 contract

Samples: Purchase of Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, personal care and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglectstandards. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract contract, at the following times: • When time the MCO enters into a Contract contract with DHHRBMS; • On an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: • Anticipated enrollment under this ContractMedicaid enrollment; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; • Numbers of network providers who are not accepting new Medicaid patients; and • Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrollees’ access to the full array of covered services, the MCO will be prohibited from serving enrollees in the deficient geographic areas.

Appears in 1 contract

Samples: Service Provider Agreement

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Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, specialty care providers, residential treatment providers, and non- traditional providers who provide SNS Socially Necessary Services in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: Primary care and specialist providers who are trained or experienced in trauma- trauma-informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees members covered under this Contractcontract; and Providers who have knowledge and experience in identifying child abuse and neglect. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract Contract, at the following times: • When time the MCO enters into a Contract with DHHR; • On on an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHR) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: Anticipated member enrollment under this Contractcontract; Expected utilization of services, taking into consideration the characteristics and health care needs of the specific populations covered by the MCO; Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all contracted services; Numbers of network providers who are not accepting new patients; and Geographic location of providers and enrollees, considering distance, travel time, the means of transportation ordinarily used by these enrollees, and whether the location provides physical access for enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrolleesmembers’ access to the full array of covered services, the MCO will be prohibited from serving enrollees members in the deficient geographic areas.

Appears in 1 contract

Samples: Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract Contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglect. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract Contract, at the following times: • When time the MCO enters into a Contract with DHHRBMS; • On on an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: • Anticipated enrollment under this ContractMedicaid enrollment; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; • Numbers of network providers who are not accepting new Medicaid patients; and • Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHRBMS, or is unable to ensure enrolleesmembers’ access to the full array of covered services, the MCO will be prohibited from serving enrollees members in the deficient geographic areas.

Appears in 1 contract

Samples: Model Purchase of Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, and specialty care providers, residential treatment providers, and non- traditional providers who provide SNS in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract Contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s BMS’ Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees covered under this Contract; and • Providers who have knowledge and experience in identifying child abuse and neglect. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract Contract, at the following times: • When time the MCO enters into a Contract with DHHRBMS; • On on an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHRBMS) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: Anticipated enrollment under this ContractMedicaid enrollment; Expected utilization of services, taking into consideration the characteristics and health care needs of the specific Medicaid populations covered represented by the MCO; Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all the contracted Medicaid services; Numbers of network providers who are not accepting new Medicaid patients; and Geographic location of providers and Medicaid enrollees, considering distance, travel time, the means of transportation ordinarily used by these Medicaid enrollees, and whether the location provides physical access for Medicaid enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHRBMS, or is unable to ensure enrolleesmembers’ access to the full array of covered services, the MCO will be prohibited from serving enrollees members in the deficient geographic areas.

Appears in 1 contract

Samples: Model Purchase of Service Provider Agreement

Network Capable of Full Array of Services. The MCO must establish and maintain provider networks in geographically accessible locations for the populations to be served. These networks must be comprised of hospitals, primary care providers (PCPs), dental, specialty care providers, residential treatment providers, and non- traditional providers who provide SNS Socially Necessary Services in sufficient numbers to make available all covered services as required by the availability and access standards of the contract. The MCO must maintain a sufficient number, mix, and geographic distribution of providers. The MCO must contract with sufficient numbers of providers to maintain sufficient access in accordance with DHHR’s Medicaid managed care network standards and SNS provider network standards for all enrollees, including those with limited English proficiency or physical or mental disabilities. The Provider network must include the following: • Primary care and specialist providers who are trained or experienced in trauma- trauma-informed approach to care and in treating individuals with complex special needs, including all the population which comprises the enrollees members covered under this Contractcontract; and • Providers who have knowledge and experience in identifying child abuse and neglect. The MCO must submit to the Department written documentation of the adequacy of its provider network as set forth in this Contract Contract, at the following times: • When time the MCO enters into a Contract with DHHR; • On on an annual basis; • When when there has been a significant change in MCO operations; • When when services, benefits, geographic service areas, or payments have been changed; or • When there is enrollment of a new population in the MCO. The MCO must contract with the full array of providers necessary to deliver a level of care that is at least equal to the community norms and meet the travel time, appointment scheduling, and waiting time standards included in this contract. The MCO must maintain and monitor a network of appropriate, credentialed providers, supported by written arrangements, that is sufficient to provide adequate access (as defined by DHHR) to covered services (including the appropriate range of preventive, primary care, and specialty services) and to meet the needs of the population served. In establishing and maintaining the network, the MCO must consider the following: • Anticipated member enrollment under this Contractcontract; • Expected utilization of services, taking into consideration the characteristics and health care needs of the specific populations covered by the MCO; • Numbers and types (in terms of training, experience, and specialization) of providers required to furnish all contracted services; • Numbers of network providers who are not accepting new patients; and • Geographic location of providers and enrollees, considering distance, travel time, the means of transportation ordinarily used by these enrollees, and whether the location provides physical access for enrollees with disabilities. If the MCO fails to build and/or maintain a provider network that meets the managed care network adequacy standards established by DHHR, or is unable to ensure enrolleesmembers’ access to the full array of covered services, the MCO will be prohibited from serving enrollees members in the deficient geographic areas.

Appears in 1 contract

Samples: Service Provider Agreement

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