Common use of Network Development Clause in Contracts

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 that may affect access, availability and network composition. FSSA will regularly and routinely monitor network access, availability and adequacy. FSSA will impose remedies, as set forth in Contract Exhibit 2, or require the Contractor to maintain an open network, if the Contractor fails to meet the network composition requirements.

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\ 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 that may affect access, availability and network composition. FSSA will regularly and routinely monitor network access, availability and adequacy. FSSA will impose remedies, as set forth in Contract Exhibit 2, or require the Contractor to maintain an open network, if the Contractor fails to meet the network composition requirements.

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 that may affect access, availability and network composition. FSSA will regularly and routinely monitor network access, availability and adequacy. FSSA will impose remedies, as set forth in Contract Exhibit 2, or require the Contractor to maintain an open network, if the Contractor fails to meet the network composition requirements.