Common use of Physical Health Services Clause in Contracts

Physical Health Services. For each Provider type, for each Service Area, the Contractor shall have at least the specified number of Providers within at least the specified time or the specified distance of Enrollees’ residences. If no time or distance is indicated, the Contractor shall have at least one Provider located anywhere in the Commonwealth. Primary Care, OB/GYN, Pharmacy, and Certain Medical Facilities Provider Type Minimum Number of Providers Time (minutes) Distance (miles) Adult PCP (all Service Areas except Oak Bluffs and Nantucket) 2 30 15 Adult PCP (Oak Bluffs and Nantucket Service Areas only) 2 40 40 Pediatric PCP (all Service Areas except Oak Bluffs and Nantucket) 2 30 15 Pediatric PCP (Oak Bluffs and Nantucket Service Areas only) 2 40 40 Hospital (Acute Inpatient Services) 1 40 20 Urgent Care 1 30 15 Rehabilitation Hospital 1 60 30 OB/GYN 2 30 15 Pharmacy 1 30 15 For the Hospital (Acute Inpatient Services) requirement above, for Oaks Bluff and Nantucket Service Areas only, the Contractor may meet this requirement by including in its Provider Network any hospitals located in these Service Areas that provide acute inpatient services or the closest hospital located outside these Service Areas that provide acute inpatient services. Other Physical Health Specialty Providers Provider Type Minimum Number of Providers Time (min) Distance (miles) Allergy 1 - - Anesthesiology 1 40 20 Audiology 1 40 20 Cardiology 1 40 20 Dermatology 1 40 20 Emergency Medicine 1 40 20 Endocrinology 1 40 20 Gastroenterology 1 40 20 General Surgery 1 40 20 Hematology 1 40 20 Infectious Disease 1 40 20 Medical Oncology 1 40 20 Nephrology 1 40 20 Neurology 1 40 20 Ophthalmology 1 40 20 Oral Surgery 1 - - Orthopedic Surgery 1 40 20 Otolaryngology 1 40 20 Physiatry 1 40 20 Plastic Surgery 1 - - Podiatry 1 40 20 Psychiatry 1 40 20 Pulmonology 1 40 20 Rheumatology 1 40 20 Urology 1 40 20 Vascular Surgery 1 - - For Oaks Bluff and Nantucket Service Areas only, the Contractor shall have at least one Provider in the above specialties, excluding Allergy, Oral Surgery, Plastic Surgery, and Vascular Surgery, within 40 miles or 40 minutes from Enrollees’ residences.