Network Development. OMPP requires the Contractor to develop and maintain a comprehensive network to provide services to its Hoosier Healthwise members. The network must include providers serving special needs populations, including providers serving children with special health care needs. The Contractor shall develop a comprehensive network prior to the effective date of the Contract. The Contractor shall be required during the readiness review process to demonstrate network adequacy through the submission of Geo Access reports in the manner and timeframe required by OMPP. The Contractor shall be required to have an open network and accept any IHCP provider acting within his or her scope of practice until the Contractor demonstrates that it meets the access requirements. OMPP reserves the right to delay initial member enrollment in the Contractor’s plan if the Contractor fails to demonstrate a complete and comprehensive network. With approval from OMPP, Contractors that can demonstrate that they have met all access, availability and network composition requirements may require members to use in-network providers, with the exception of certain self-referral providers as described in Section 3.2. The Contractor must provide ninety (90) calendar day advance notice to OMPP of changes to the network that may affect access, availability and network composition. OMPP shall regularly and routinely monitor network access, availability and adequacy. OMPP shall impose remedies, as set forth in Exhibit 2, or require the Contractor to maintain an open network, if the Contractor fails to meet the network composition requirements. In accordance with 42 CFR 438.206, the Contractor shall maintain and monitor the provider network. The Contractor shall establish written agreements with all network providers as further described in Section 5.4. In establishing and maintaining the network, the Contractor must consider the following elements: The anticipated enrollment; The expected utilization of services, taking into consideration the characteristics and health care needs of the Contractor’s Hoosier Healthwise members; The numbers and types (in terms of training, experience and specialization) of providers required to furnish the contracted services; The numbers of network providers who are not accepting new members; and The geographic location of providers and members, considering distance, travel time, the means of transportation ordinarily used by members and whether the location p...
Network Development. FSSA requires the Contractor to develop and maintain a comprehensive network to provide services to its Hoosier Care Connect members. The Contractor must develop a comprehensive network prior to the effective date of the Contract and prior to receiving enrollment. The Contractor shall be required during the Readiness Review process, as described in Attachment H, to demonstrate network adequacy through the submission of Geo Access reports in the manner and timeframe required by FSSA. The Contractor shall be required to have an open network and accept any IHCP provider acting within his or her scope of practice until the Contractor demonstrates that it meets the access requirements. FSSA reserves the right to delay initial member enrollment in the Contractor’s plan if the Contractor fails to demonstrate a complete and comprehensive network. With approval from FSSA, Contractors that can demonstrate that they have met all access, availability and network composition requirements may require members to use in-network providers, with the exception of certain self-referral providers as described in Section 3.1. Additionally, as described in Section 3.15, during the first ninety (90) calendar days of the Contract, the Contractor shall be required to permit members to continue receiving services from a non-network provider even if FSSA has approved closure of the network. In accordance with 42 CFR 438.206, the Contractor must maintain and monitor the provider network. The Contractor will establish written agreements with all network providers as further described in Section 6.5. In establishing and maintaining the network, the Contractor must consider the following: The anticipated enrollment; The expected utilization of services, taking into consideration the characteristics and health care needs of the Contractor’s Hoosier Care Connect enrollment and anticipated enrollment; The number and types (in terms of training, experience, specialization, and expertise in xxxxxx care issues, pediatrics, and behavioral health) of providers required to furnish the contracted services; The number of network providers who are not accepting new members; and\ The geographic location of providers and members, considering distance, travel time, the means of transportation ordinarily used by members, and whether the location provides physical access for members with disabilities. The Contractor must provide ninety (90) calendar days advance notice to FSSA of changes to the...
Network Development. Vendor shall arrange for Participating Providers to provide Covered Services to Members. United may recommend to Vendor that certain providers become Participating Providers. In no case shall this provision be construed to obligate Vendor to contract with or make use of any particular health care facility or professional. Vendor retains full and complete rights to terminate a Participating Provider’s Provider Agreement with Vendor. Vendor makes no representations or guarantees regarding the continued availability of any Participating Provider. Vendor shall provide United with electronic access in a mutually agreeable format to a listing of Participating Providers that Vendor will update monthly. In the event of termination of a Participating Provider, Vendor shall assist Members in transitioning to a new Participating Provider within a reasonable time or such timeframe as required by applicable state and/or federal law. Any material changes to the composition of the Provider network may be subject to prior written notification to the applicable state and/or federal regulatory authorities.
Network Development. The Contractor shall develop and maintain a provider network that is supported by written agreements which is sufficient to provide all covered services to AHCCCS members. The Contractor shall ensure covered services are reasonably accessible in terms of location and hours of operation. The Contractor must provide a comprehensive provider network that ensures its membership has access at least equal to community norms. Services shall be as accessible to AHCCCS members in terms of timeliness, amount, duration and scope as those services are available to non-AHCCCS persons within the same service xxxx [00 XXX 438.210(a)(2)]. The Contractor is encouraged to have available non-emergent after-hours physician or primary care services within its network. If the Contractor’s network is unable to provide medically necessary services required under contract, the Contractor must adequately and timely cover these services through an out of network provider until a network provider is contracted. The Contractor shall ensure coordination with respect to authorization and payment issues in these circumstances [42 CFR 438.206(b)(4) and (5)]. The Contractor is expected to design a network that provides a geographically convenient flow of patients among network providers. The provider network shall be designed to reflect the needs and service requirements of AHCCCS’ culturally and linguistically diverse member population. The Contractor shall design its provider networks to maximize the availability of community based primary care and specialty care access and that reduces utilization of emergency services, one day hospital admissions, hospital based outpatient surgeries when lower cost surgery centers are available, and hospitalization for preventable medical problems. There shall be sufficient personnel for the provision of covered services, including emergency medical care on a 24-hour-a-day, xxxxx-xxxx-x-xxxx xxxxx [00 XXX 438.206(c)(1)(iii)]. The Contractor shall develop and maintain a Provider Network Development and Management Plan which ensures that the provision of covered services will occur as stated above [42 CFR 438.207(b)]. The requirements for the Network Development and Management Plan are found in ACOM Policy 415. The Network Development and Management Plan shall be evaluated, updated annually and submitted to AHCCCS as specified in Attachment F3, Contractor Chart of Deliverables. The submission of the network management and development plan to AHCCCS is an...
Network Development. 5.9.1 During the Term the Operators shall use reasonable endeavours to maintain the overall level of commercial bus operation in Tyne and Wear as of the Effective Date using the resource levels existing as at the Effective Date.
Network Development. Contractor shall develop and maintain a provider network in compliance with the terms of this section and 42 CFR § 438.206. Contractor shall ensure that all of its Participating Providers can respond to the cultural and linguistic needs of its Attributed Members. The network shall be able to meet the unique needs of its Members, particularly those with special health care needs. Contractor will be required to participate in any state efforts to promote the delivery of covered services in a culturally competent manner. Contractor shall ensure that all of its network providers are enrolled as Medicaid providers and follow all Vermont Medicaid provider enrollment criteria. Contractor must monitor medical care standards to evaluate access to care and quality of services provided to Members, evaluate providers regarding their practice patterns, and have a mechanism in place to address quality of care concerns.
Network Development. Subject to applicable Laws, to the extent required under Payor Contracts or to meet VA’s and Manager’s obligations thereunder and to the extent desirable to facilitate servicing new or potential Payor Contracts, Manager may assist VA in developing a provider network for the provision of Outside Provider Services, including:
Network Development. BGN shall undertake the following activities in accordance with the Development Requirements:
Network Development. Subject to applicable Laws, to the extent required under Payor Contracts or to meet the Practice Operator’s and Manager’s obligations thereunder and to the extent desirable to facilitate servicing new or potential Payor Contracts, Manager may assist the Practice Operator in developing a provider network for the provision of Outside Provider Services, including:
Network Development. FSSA requires the Contractor to develop and maintain a comprehensive network to provide services to its Hoosier Care Connect members. The Contractor must develop a comprehensive network prior to the effective date of the Contract and prior to receiving enrollment. The Contractor shall be required during the Readiness Review process to demonstrate network adequacy through the submission of Geo Access reports and provider lists in the manner and timeframe required by FSSA. The Contractor shall be required to have an open network and accept any IHCP provider acting within his or her scope of practice until the Contractor demonstrates that it meets the access requirements. FSSA reserves the right to delay initial member enrollment in the Contractor’s plan if the Contractor fails to demonstrate a complete and comprehensive network. With approval from FSSA, Contractors that can demonstrate that they have met all access, availability and network composition requirements may require members to use in-network providers, with the exception of certain self-referral providers as described in Section 3.1. Additionally, as described in Section 3.15, during the first ninety (90) calendar days of the Contract, the Contractor shall be required to permit members to continue receiving services from a non-network provider even if FSSA has approved closure of the network. If a member seeks covered services from an in-network provider that does not provide those services due to moral or religious objections, with the member having no other in-network provider options, the Contractor must have a process by which the member can seek services from an out-of-network provider. In accordance with 42 CFR 438.206, the Contractor must maintain and monitor the provider network. The Contractor will establish written agreements with all network providers as further described in Section 6.5. In establishing and maintaining the network, the Contractor must consider the following: • The anticipated enrollment; • The expected utilization of services, taking into consideration the characteristics and health care needs of the Contractor’s Hoosier Care Connect enrollment and anticipated enrollment; • The number and types (in terms of training, experience, specialization, and expertise in xxxxxx care issues, pediatrics, and behavioral health) of providers required to furnish the contracted services; • The number of network providers who are not accepting new members;
