Specialist and Ancillary Provider Network Requirements Sample Clauses

Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for each specialty type within sixty (60) miles of the member’s residence. For providers identified with two asterisks (**), the Contractor shall provide, at a minimum, one specialty provider within ninety (90) miles of the member’s residence. Specialties Ancillary Providers ⮚ Anesthesiologists* ⮚ Cardiologists* ⮚ Cardiothoracic surgeons** ⮚ Dentists/Oral Surgeons * ⮚ Dermatologists** ⮚ Endocrinologists* ⮚ Gastroenterologists* ⮚ General surgeons* ⮚ Hematologists ⮚ Infectious disease specialists** ⮚ Interventional radiologists** ⮚ Nephrologists* ⮚ Neurologists* ⮚ Neurosurgeons** ⮚ Non-hospital based anesthesiologist (e.g., pain medicine)** ⮚ OB/GYNs ⮚ Occupational therapists* ⮚ Occupational therapists* ⮚ Oncologists* ⮚ Ophthalmologists* ⮚ Diagnostic testing* ⮚ Durable Medical Equipment ⮚ Home Health ⮚ Prosthetic suppliers** EXHIBIT 1.E
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Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network of PMPs, the Contractor shall provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers. As with PMPs, specialist and ancillary providers shall not be limited to serve in only one MCE network. In addition, physicians contracted as a PMP with one Contractor may contract as a specialist with other MCEs. The Contractor shall ensure that specialists are maintaining the medical care standards and practice guidelines detailed in the IHCP Provider Manual. OMPP requires the Contractor to monitor medical care standards to evaluate access to care and quality of services provided to members and to evaluate providers regarding their practice patterns. OMPP requires the Contractor to develop and maintain a comprehensive network of specialty providers listed below. For providers identified with an asterisk (*), the Contractor shall provide, at a minimum, two providers for each specialty type within sixty
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Specialist and Ancillary Provider Network Requirements. In addition to maintaining a network with PMP specialties, the MCO must provide and maintain a comprehensive network of IHCP provider specialists and ancillary providers for all its members in the mandatory RBMC counties. Specialty providers participating in Hoosier Healthwise may contract with both the PrimeStep program and the MCO. Unlike PMPs, specialist and ancillary providers are not limited to serve in only one MCO network. In addition, physicians contracted as a PMP with one MCO may contract as a specialist with the other Hoosier Healthwise plans. OMPP encourages the MCO to develop a comprehensive network of specialty providers throughout the State. However, the MCO network in the mandatory RBMC counties must include, at a minimum: • Two specialty providers of each provider type listed below who have locations of service in the mandatory RBMC county; or • A combination of two specialty providers for each type listed below in any one of the following combinations: • One of each type of specialty provider with a service location in the mandatory RBMC county, and • One of each type of specialty provider with a service location in a county contiguous to the mandatory RBMC county, or HOOSIER HEALTHWISE STATE/MCO CONTRACT CONTRACT ATTACHMENT 1: MCO SCOPE OF WORK • One of each type of specialty provider with a service location in a county within 60 miles or 60 minutes from the member’s residence zip code For the purposes of its initial network development, the MCO must demonstrate its specialty providers’ service locations are within 60 miles or 60 minutes of the population center zip codes listed below for each mandatory RBMC county: Mandatory RBMC Counties Xxxxxxxxxx Xxxxxx Xxx Xxxxx Xxxxx 46806 Delaware 47302 Elkhart 46516 Grant 46953 Xxxxxx 46901 Xxxxxxx 46131 Lake 46312 XxXxxxx 46360 Madison 46016 Xxxxxx 46218 Xxxxxx 46151 Xxxxxx 46368 St. Xxxxxx 46628 The MCO must include a minimum of two specialists and ancillary providers of each type identified below for each mandatory RBMC county within the access standards described above: • Physician Specialties • Cardiologist • Orthopedic Surgeon • Otologist or Otolaryngologist • Urologist • Self-referral Practitioners • Chiropractor • Family Planning Practitioner • Ophthalmologist or Optometrist • Podiatrist • Ancillary Providers • Durable Medical Equipment Provider • Home Health • Pharmacy HOOSIER HEALTHWISE STATE/MCO CONTRACT CONTRACT ATTACHMENT 1: MCO SCOPE OF WORK Considering the nature of the services so...
Sample 1

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