Network Adequacy. 35.1. The CONTRACTOR shall ensure that all services covered under this Agreement are available and accessible to clients in a timely manner and in accordance with the network adequacy standards required by regulation. (42 C.F.R. §438.206 (a), (c)).
Network Adequacy. A. The Contractor shall ensure that all services covered under this Contract are available and accessible to beneficiaries in a timely manner. 42 C.F.R. § 438.206(a)
Network Adequacy. 15.1 The Contractor shall ensure that all services covered under this Contract are available and accessible to beneficiaries in a timely manner and in accordance with the network adequacy standards required by regulation. (42 C.F.R. § 438.206 (a), (c)). See also, TIMELY ACCESS REQUIREMENTS.
Network Adequacy a) Network Standards. Contractor’s QHPs shall comply with the network adequacy standards established by the applicable State Regulators responsible for oversight of Contractor, including, those set forth at Health and Safety Code § 1367.03 and 28 CCR § 1300.67.2 (if Contractor is a licensed health care service plan) or Insurance Code § 10133.5 and 10 CCR § 2240 et seq. (if Contractor is regulated by CDI), and, as applicable, other laws, rules, and regulations, including, those set forth at 45 C.F.R. § 156.230. Contractor shall cooperate with Covered California to implement network changes as necessary to address concerns identified by Covered California.
Network Adequacy. The Contractor shall submit, in a manner and format determined by the Department, documentation to demonstrate compliance with the Department’s requirements for availability and accessibility of services, including the adequacy of the provider network. (42 C.F.R. § 438.604(a)(5).)
Network Adequacy. Carrier shall comply with network adequacy policies set forth in State and federal laws and regulations, including, but not limited to, 45 CFR §156.230 and requirements established by the OSI.
Network Adequacy. A. IDHW will regularly monitor the Health Plan’s network and will impose corrective action in accordance with the terms of the contract when the Health Plan fails to meet the network adequacy standards.
Network Adequacy. 2.7.1.1. The ICO must maintain a Provider Network sufficient to provide all Enrollees with access to the full range of Covered Services, including the appropriate range of preventive, primary care, and specialty services, behavioral health services, other specialty services, and all other services required in 42 C.F.R. §§422.112, 423.120, and 438.206, and under this Contract (see Covered Services in Appendix A), taking into consideration:
Network Adequacy. State Medicaid standards shall be utilized for long-term supports and services, as described below, or for other services for which Medicaid is exclusive, and Medicare standards shall be utilized for pharmacy benefits and for other services for which Medicare is primary, unless applicable Medicaid standards for such services are more stringent. Home health and durable medical equipment requirements, as well as any other services for which Medicaid and Medicare may overlap, shall be subject to the more stringent of the applicable Medicare and Medicaid standards. Ohio has developed transition requirements that specify continuation of existing providers for nursing facilities, long term supports and services and behavioral health providers (see Table 7-B, “ICDS Plan Transition Requirements at Enrollment” below). Ohio also requires that ICDS Plans provide and arrange for timely access to all medically-necessary services covered by Medicaid. Both the State and CMS will monitor access to services through survey, utilization, and complaints data to assess needs to ICDS Plan network corrective actions. In addition to these protections, minimum LTSS standards for ICDS Plans are below. Ohio will finalize the standards, based on administrative data and based on stakeholder input. CMS and the State will monitor access to care and the prevalence of needs indicated through Enrollee assessments, and, based on those findings, may require that ICDS Plans initiate further network expansion over the course of the Demonstration. • At least two community LTSS Providers in each region for the following services: Enhanced Community Living, Homemaker, Waiver Transportation, Nutritional Consultation, Assisted Living, Social Work Counseling, Out of Home Respite, Home Medical Equipment and Supplemental Adaptive and Assistive Devices, Independent Living Assistance and Community Transition. • At least one adult day health and one assisted living provider within 30 miles of each zip code within the region. • At least two community LTSS Agency Providers in each region for the following services: Personal Care and Waiver Nursing. • At least five community LTSS Independent Providers, in addition to self- directed care options in which and Enrollee can choose his or her provider, in each region for the following services: Personal Care, Home Care Attendant, and Waiver Nursing. • At least one community LTSS Provider in each ICDS region for the following services: Pest Control, Home Delivere...
Network Adequacy. The Contractor must maintain a Provider Network sufficient to provide all Enrollees with access to the full range of Covered Services, including the appropriate range of preventive, Primary Care, and specialty services, behavioral health services, other specialty services, and all other services required in 42 C.F.R. §§422.112, 423.120, 438.68, and 438.206, and under this Contract (see Covered Services in Appendix A), taking into consideration:
