Common use of Sufficient geographic distribution Clause in Contracts

Sufficient geographic distribution. Covered California shall determine whether Contractor meets the requirement of a sufficient geographic distribution of care, including ECPs, and other providers in its reasonable discretion, in accordance with the conditions set forth in the Application, and based on a consideration of various factors, including: (i) the nature, type, and distribution of Contractor’s ECP contracting arrangements in each geographic rating region in which Contractor’s QHPs provides Covered Services to Enrollees, (ii) the balance of hospital and non-hospital ECPs in each geographic rating region, (iii) the inclusion in Contractor’s provider contracting network of at least 15% of entities in each applicable geographic rating region that participate in the program for limitation on prices of drugs purchased by covered entities under Section 340B of the Public Health Service Act (42 U.S.C. § 256B) (“340B Entity”), (iv) the inclusion of at least one ECP hospital in each region, (v) the inclusion of Federally Qualified Health Centers, and county hospitals, and

Sufficient geographic distribution. Covered California shall determine whether Contractor meets the requirement of a sufficient geographic distribution of care, including ECPs, and other providers in its reasonable discretion, in accordance with the conditions set forth in the Application, and based on a consideration of various factors, including: (i) the nature, type, and distribution of Contractor’s ECP contracting arrangements in each geographic rating region in which Contractor’s QHPs provides Covered Services to Enrollees, (ii) the balance of hospital and non-hospital ECPs in each geographic rating region, (iii) the inclusion in Contractor’s provider contracting network of at least 15% of entities in each applicable geographic rating region that participate in the program for limitation on prices of drugs purchased by covered entities under Section 340B of the Public Health Service Act (42 U.S.C. § 256B) (“340B Entity”), (iv) the inclusion of at least one ECP hospital in each region, (v) the inclusion of Federally Qualified Health Centers, and county hospitals, andand (vi) other factors as mutually agreed upon by Covered California and the Contractor regarding Contractor’s ability to serve the low income population.