Network Adequacy Standards. 6.1.1 In addition to what is outlined in this section of the Agreement, the PASSE must maintain and monitor an adequate network of qualified providers that is sufficient to meet the Timely Access to Care Standards defined in the PASSE Manual and in the definition of services covered under the Agreement for all Members. The network must be supported by written Provider Contracts as described in Section 6.2. The PASSE must submit documentation to DHS, in a format specified by DHS, to demonstrate:
Network Adequacy Standards a) CONTRACTOR shall meet the state standards for timely access to care and services, taking into account the urgency of need for services. CONTRACTOR shall offer hours of operation that are no less than the hours offered to commercial enrollees or that are comparable to Medicaid Fee-For-Service (FFS), if the provider serves only Medicaid enrollees. CONTRACTOR shall make services available twenty-four (24) hours a day, seven (7) days a week, when medically necessary.
Network Adequacy Standards. The Contractor’s network shall meet or exceed Federal standards in 42 CFR §438.68 and 42 CFR §438.206, as well as the full scope of access standards described in Section 4.6, Access to Care Standards. The Contractor shall regularly assess and certify through submission of quarterly reports to the Department the adequacy of its provider network and notify the Department of any major initiatives or changes to program design (e.g., expanded benefits). Refer to the Medallion
Network Adequacy Standards. 6.1.1 The DMO’s network must be supported by written Provider Agreements as described in Section 6.2. The DMO must submit documentation monthly to DHS, in a format specified by DHS, to demonstrate:
Network Adequacy Standards. The Provider-to-Enrollee Ratios; Provider Per Municipality requirements; Required Network Provider requirements, and Time and Distance requirements developed in accordance with 42 CFR 438.68, as defined by ASES in Section 9.4 to measure the adequacy and appropriateness of the Contractor’s provider network to meet the needs of the enrolled population.
Network Adequacy Standards. 9.4.1 The Contractor must maintain an Island-wide provider network that complies with the Network Adequacy Standards specified in Section 9.4. The Contractor must use Geographical-access and thermomapping to demonstrate that the contracted network is distributed across Puerto Rico such that it meets the needs of Enrollees. The Contractor shall provide adequate Access to Enrollees at all times.
