Availability and Access Standards Sample Clauses

Availability and Access Standards. This network must include a panel of primary care providers from which the enrollee may select a personal primary care provider. Requirements for adequate access state that: • Routinely used delivery sites, including PCPs’ offices and the offices of frequently used specialists, must be located within thirty (30) minutes travel time; • Basic hospital services must be located within forty-five (45) minutes travel time; and • Tertiary services must be located within sixty (60) minutes travel time. The intent of these standards is to provide for access to services at least as good, if not better, than access to care under the traditional Medicaid program. BMS will periodically publish specific network standards that define which provider types are considered “frequently used specialists” in each county or region, based on a comparison to the traditional Medicaid program or other criteria as defined by BMS. Exceptions to these standards will be permitted where the travel time standard is better than what exists in the community at large. For example if the community standard for basic hospital services is sixty (60) minutes travel time, then the MCO’s basic hospital service must be located within sixty (60) minutes travel time (not within forty-five (45) minutes travel time). MCOs will be required to comply with updated network standards within ninety (90) days of issuance, unless otherwise agreed to in writing by BMS within sixty (60) days of issuance. The MCO must ensure that the hours of operation of its providers are convenient, do not discriminate against enrollees, and are no less than the hours of operation offered to commercial enrollees or comparable to Medicaid fee-for-service. MCOs must ensure that waiting times at sites of care are kept to a minimum and ensure that the waiting time standard for Medicaid enrollees is the same standard used for commercial enrollees. Providers cannot discriminate against Medicaid enrollees in the order that patients are seen or in the order that appointments are given (providers are not permitted to schedule Medicaid-only days). When Medically Necessary, the MCO makes services available 24 hours a day, seven days a week. The MCO must establish a mechanism to ensure that providers comply with the access standards set forth in this contract. The MCO should regularly measure the extent to which providers in the network comply with these requirements and take remedial action if necessary. The MCO must ensure that services ...
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Availability and Access Standards. The MCO must ensure that all covered services, including additional or supplemental services contracted by or on behalf of Medicaid enrollees, are available and accessible as required in 42 CFR §438.68, §438.206, and §438.207. The MCO must have policies and procedures, including coverage rules, practice guidelines, payment policies and utilization management, that allow for individual medical necessity determinations. The Department has set minimum provider network adequacy standards that the MCO must meet or exceed in all geographic areas in which the MCO operates. The full list of network adequacy standards is included in Appendix K. They include standards for: • PCPs’, • Specialists; • OB/GYNs; • Basic hospital services; • Tertiary hospital services6; • Pediatric dental providers; • Behavioral Health providers and facilities; • Substance Use Disorder (SUD) providers and facilities; and • Additional providers when it promotes the objectives of the Medicaid program as determined by CMS. The intent of these standards is to provide for access to services at least as good, if not better, than access to care under the traditional Medicaid program. DHHR will periodically publish specific network standards that define which provider types are considered adult and pediatric specialists. The MCO will be required to comply with updated network standards within ninety (90) calendar days of issuance, unless otherwise agreed to in writing by DHHR within sixty (60) calendar days of issuance. During any period in which the MCO does not meet minimum network standards, the MCO must ensure that appropriate processes are implemented to adequately cover services in a timely manner out-of-network, including paying claims to out-of-network providers and ensuring that enrollees incur no additional costs, as specified in 42 CFR §438.206(b) and §457.1230(a).
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Availability and Access Standards. The MCO must ensure that all covered services, including additional or supplemental services contracted by or on behalf of Medicaid and WVCHIP enrollees, are available and accessible. The MCO must have policies and procedures, including coverage rules, practice guidelines, payment policies and utilization management, that allow for individual medical necessity determinations. Policies and procedures must outline how cases of medical necessity will be handled when medical service limits or prescription limits are met, per BMS’ policies. BMS has set minimum provider network adequacy standards that the MCO must meet or exceed, as set forth in Appendix I. They include adult and pediatric standards for: • PCPs; • Specialists; • OB/GYNs; • Basic hospital services; • Tertiary hospital services7; • Pediatric and adult dental providers, • Behavioral Health providers and facilities; • Substance Use Disorder (SUD) providers and facilities; • Psychiatric Residential Treatment Facilities (PRTF); and • Additional providers when it promotes the objectives of the Medicaid and WVCHIP programs as determined by CMS. The intent of these standards is to provide for access to services at least as good, if not better, than access to care under the traditional Medicaid and WVCHIP programs. BMS will periodically publish specific network standards that define which provider types are considered adult and pediatric specialists. The MCO will be required to comply with updated network standards within ninety (90) calendar days of issuance, unless otherwise agreed to in writing by BMS within sixty (60) calendar days of issuance. During any period in which the MCO does not meet minimum network standards, the MCO must ensure that appropriate processes are implemented to adequately cover services in a timely manner out-of-network, including paying claims to out-of-network providers and ensuring that enrollees incur no additional costs.
Sample 1
Availability and Access Standards. This network must include a panel of primary care providers from which the enrollee may select a personal primary care provider. Requirements for adequate access state that: • Routinely used delivery sites, including PCPs’ offices and the offices of frequently used specialists, must be located within thirty (30) minutes travel time, including but not limited to: pediatric primary care, OB/GYN, pediatric mental health providers, pediatric Substance Use Disorder (SUD) providers, pediatric specialists, pediatric dental; • Basic hospital services must be located within forty-five (45) minutes travel time; and • Tertiary services must be located within sixty (60) minutes travel time. The intent of these standards is to provide for access to services at least as good, if not better, than access to care under the traditional Medicaid program. DHHR will periodically publish specific network standards that define which provider types are considered “frequently used specialists” in each county or region, based on a comparison to the traditional Medicaid program or other criteria as defined by DHHR. Exceptions to these standards will be permitted where the travel time standard is better than what exists in the community at large. For example if the community standard for basic hospital services is sixty (60) minutes travel time, then the MCO’s basic hospital service must be located within sixty (60) minutes travel time (not within forty-five
Sample 1
Availability and Access Standards. The MCO must ensure that all covered services, including additional or supplemental services contracted by or on behalf of Medicaid enrollees, are available and accessible. The MCO must have policies and procedures, including coverage rules, practice guidelines, payment policies and utilization management, that allow for individual medical necessity determinations. BMS has set minimum provider network adequacy standards that the MCO must meet or exceed in all geographic areas in which the MCO operates. The full list of network adequacy standards are included in Appendix J. They include adult and pediatric standards for: • PCPs ; • Specialists; • OB/GYNs; • Basic hospital services; • Tertiary hospital services7; • Pediatric dental providers • Behavioral Health providers and facilities; • Substance Use Disorder (SUD) providers and facilities; and • Additional providers when it promotes the objectives of the Medicaid program as determined by CMS.
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Related to Availability and Access Standards

  • Inclusion and accessibility The institution will provide support to incoming mobile participants with fewer opportunities, according to the requirements of the Erasmus Charter for Higher Education. Information and assistance can be provided by the following contact points and information sources: Country Available infrastructure adjusted for people with Description of infrastructure Contact e-mail and phone Website for information FROM TO CZ PL --- --- --- PL CZ --- --- xxxx://xxx.xxxxxxxxx.xxxx.xx/?la ng=en Country Available support services for people with Description of infrastructure Contact e-mail and phone Website for information FROM TO CZ PL --- --- --- PL CZ --- --- ---

  • Electronic and Information Resources Accessibility and Security Standards a. Applicability: The following Electronic and Information Resources (“EIR”) requirements apply to the Contract because the Grantee performs services that include EIR that the System Agency's employees are required or permitted to access or members of the public are required or permitted to access. This Section does not apply to incidental uses of EIR in the performance of the Agreement, unless the Parties agree that the EIR will become property of the State of Texas or will be used by HHSC’s clients or recipients after completion of the Agreement. Nothing in this section is intended to prescribe the use of particular designs or technologies or to prevent the use of alternative technologies, provided they result in substantially equivalent or greater access to and use of a Product.

  • Fire, Life Safety, and Accessibility Codes The following codes, in the versions approved by the Georgia State Fire Marshal/Fire Safety Commissioner and Department of Human Resources, shall be used. The Design Professional will designate any additional codes or special modifications in the Supplementary General Conditions.

  • Power Supply Information and Access to Information 12 POWER SUPPLY INFORMATION

  • Security and Access The Executive agrees and covenants (a) to comply with all Company security policies and procedures as in force from time to time including without limitation those regarding computer equipment, telephone systems, voicemail systems, facilities access, monitoring, key cards, access codes, Company intranet, internet, social media and instant messaging systems, computer systems, e-mail systems, computer networks, document storage systems, software, data security, encryption, firewalls, passwords and any and all other Company facilities, IT resources and communication technologies (“Facilities Information Technology and Access Resources”); (b) not to access or use any Facilities and Information Technology Resources except as authorized by the Company; and (iii) not to access or use any Facilities and Information Technology Resources in any manner after the termination of the Executive’s employment by the Company, whether termination is voluntary or involuntary. The Executive agrees to notify the Company promptly in the event he learns of any violation of the foregoing by others, or of any other misappropriation or unauthorized access, use, reproduction or reverse engineering of, or tampering with any Facilities and Information Technology Access Resources or other Company property or materials by others.

  • Information Technology Accessibility Standards Any information technology related products or services purchased, used or maintained through this Grant must be compatible with the principles and goals contained in the Electronic and Information Technology Accessibility Standards adopted by the Architectural and Transportation Barriers Compliance Board under Section 508 of the federal Rehabilitation Act of 1973 (29 U.S.C. §794d), as amended. The federal Electronic and Information Technology Accessibility Standards can be found at: xxxx://xxx.xxxxxx-xxxxx.xxx/508.htm.

  • Control and Access to Information The Financial Mechanism Committee, the EFTA Board of Auditors and their representatives have the right to carry out any technical or financial mission or review they consider necessary to follow the planning, implementation and monitoring of programmes and projects as well as the use of funds. The Beneficiary State shall provide all necessary assistance, information and documentation.

  • AUDIT AND ACCESS Twelve (12) Months after the expiry of the Call-Off Agreement Period or following termination of this Call-Off Agreement.

  • Records Retention and Access The Contractor shall maintain accurate, current, and complete records of the financial activity of this Contract which sufficiently and properly document and calculate all charges billed to the Agency throughout the term of this Contract and for a period of at least five (5) years following the date of final payment or completion of any required audit (whichever is later). If any litigation, claim, negotiation, audit or other action involving the records has been started before the expiration of the five (5) year period, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five (5) year period, whichever is later. The Contractor shall permit the Agency, the Auditor of the State or any other authorized representative of the State and where federal funds are involved, the Comptroller General of the United States or any other authorized representative of the United States government, to access and examine, audit, excerpt and transcribe any directly pertinent books, documents, papers, electronic or optically stored and created records or other records of the Contractor relating to orders, invoices or payments or any other documentation or materials pertaining to this Contract, wherever such records may be located. The Contractor shall not impose a charge for audit or examination of the Contractor’s books and records. Based on the audit findings, the Agency reserves the right to address the Contractor’s board or other managing entity regarding performance and expenditures. When state or federal law or the terms of this Contract require compliance with OMB Circular A-87, A-110, or other similar provision addressing proper use of government funds, the Contractor shall comply with these additional records retention and access requirements:

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