Provider Network Requirements. The Contractor shall develop and maintain a provider network in compliance with the terms of this section. The Contractor shall ensure that its provider network is supported by written provider agreements, is available and geographically accessible and provides adequate numbers of facilities, physicians, pharmacies, ancillary providers, service locations and personnel for the provision of high-quality covered services for its members, in accordance with 42 CFR 438.206, which relates to availability of services. The Contractor shall also ensure that all of its contracted providers can respond to the cultural, racial and linguistic needs of its member populations. The network shall be able to handle the unique needs of its members, particularly those with special health care needs. The Contractor will be required to participate in any state efforts to promote the delivery of covered services in a culturally competent manner. The Contractor shall ensure all network providers who, in accordance with IHCP policy, are provider types eligible and required to enroll as an IHCP provider, are enrolled IHCP providers. In some cases, members may receive out-of-network services. In order to receive reimbursement from the Contractor, out-of-network providers shall be IHCP providers. The Contractor shall encourage out-of-network providers to enroll in the IHCP, particularly emergency services providers, as well as providers based in non-traditional urgent health care settings such as retail clinics. An out-of-network provider shall be enrolled in the IHCP in order to receive payment from the Contractor. Further information about IHCP Provider Enrollment is located at: xxxx://xxxxxxxx.xxxxxxxxxxxxxxx.xxx/become-a-provider/ihcp-provider-enrollment- transactions.aspx
Provider Network Requirements. The Contractor shall develop and maintain a provider network in compliance with the terms of this section. Individuals with disabilities and chronic health conditions often spend years finding providers with the appropriate clinical knowledge and competencies to meet their needs. The Contractor shall implement strategies to ensure the maintenance of these established provider relationships and develop a network able to handle the special health care needs of the Hoosier Care Connect population. In accordance with 42 CFR 438.3(l) the Contractor must allow each member to choose his or her health professional to the extent possible and appropriate. The Contractor must ensure that its provider network is supported by written provider agreements, is available and geographically accessible and provides an adequate number of facilities, physicians, pharmacies, ancillary providers, service locations and personnel for the provision of high-quality covered services for its members, in accordance with 42 CFR 438.206. The Contractor must also ensure that all of its contracted providers can respond to the cultural, racial and linguistic needs of its members. The Contractor must ensure all network providers who, in accordance with IHCP policy, are provider types eligible and required to enroll as an IHCP provider, are enrolled IHCP providers. In some cases, members may receive out-of-network services. In order to receive reimbursement from the Contractor, out-of-network providers must be IHCP providers. The Contractor shall encourage out-of- network providers, particularly emergency services providers, to enroll in the IHCP. Further information about IHCP Provider Enrollment is located at: xxxx://xxxxxxxx.xxxxxxxxxxxxxxx.xxx/become-a-provider/ihcp-provider-enrollment- transactions.aspx
Provider Network Requirements. Provider networks and all provider types within the network shall be reviewed on a county basis, i.e., must be located within the county except where indicated. The contractor shall monitor the capacity of each of its providers and decrease ratio limits as needed to maintain appointment availability standards.
Provider Network Requirements. The Contractor shall develop and maintain a provider network in compliance with the terms of this section. The Contractor shall ensure that its provider network is supported by written provider agreements, is available and geographically accessible and provides adequate numbers of facilities, physicians, pharmacies, ancillary providers, service locations and personnel for the provision of high-quality covered services for its members, in accordance with 42 CFR 438.206, which relates to availability of services. The Contractor shall also ensure that all of its contracted providers can respond to the cultural, racial and linguistic needs of its member populations. The network shall be able to handle the unique needs of its members, particularly those with special health care needs. The Contractor will be required to participate in any state efforts to promote the delivery of covered services in a culturally competent manner. EXHIBIT 1.E
Provider Network Requirements. 1. Geographic Access Standards In addition to maintaining in its network a sufficient number of Providers to provide all services to its Members, the Contractor shall meet the geographic access standards for all Members set forth in Table 6.
Provider Network Requirements. 7.1 PROVIDER ACCESSIBILITY ----------------------
Provider Network Requirements. When a mobile dental van’s use is associated with health fairs or other one-time events, services will be limited to oral screenings, exams, fluoride varnish, prophylaxis and palliative care to treat an acute condition. State Board regulations must still be followed. The MCO must maintain documentation for all locations served to include schedule of time and days. Money Follows the Person or MFP--a federal demonstration project that assists individuals who meet CMS eligibility requirements to transition from institutions to the community, and helps the State strengthen and improve community based systems of long-term care for low-income seniors and individuals with disabilities. MFP does this by giving states an enhanced federal reimbursement for the cost of services provided to individuals who enroll in the Home and Community Based Services (HCBS) waiver program or in MLTSS when they move to the community. Multilingual--at a minimum, English and Spanish and any other language which is spoken by 200 enrollees or five percent of the enrolled Medicaid population of the Contractor’s plan, whichever is greater. NCQA--the National Committee for Quality Assurance. Newborn--an infant born to a mother enrolled in a Contractor’s plan at the time of birth. New Jersey State Plan or State Plan--the DHS/DMAHS document, filed with and approved by CMS, that describes the New Jersey Medicaid/NJ FamilyCare program. N.J.A.C.--New Jersey Administrative Code. NJ Choice Assessment System--consists of the interRAI Home Care, Version 9.1 assessment form with NJ specific revisions (NJ Choice), Home Care Clinical Assessment Protocols (CAPS), Home Care case mix categories (RUG-III/HC), and the NJ specific Interim Plan of Care (IPOC) form. This standardized assessment system is used to determine clinical eligibility for MLTSS services pursuant to N.J.A.C. 8:85 – 2.1, clinical eligibility for Medical Day Care services pursuant to N.J.A.C. 10:164, and to inform and document Options Counseling. NJ FamilyCare Program Eligibility Groups Include:
Provider Network Requirements. B. The contractor shall ensure that its provider network includes, at a minimum:
Provider Network Requirements a. The Contractor shall establish and maintain a provider network that is capable of delivering Medically Necessary Covered Services under this Subcontract, including the provision of care to members with limited proficiency in English, in accordance with required appointment standards, professional requirements and best practices. The Comprehensive Service Network shall provide a full continuum of treatment, rehabilitative, supportive and ancillary services for:
Provider Network Requirements. 1. Network Development, monitoring and maintenance
