Common use of Network Capacity Clause in Contracts

Network Capacity. The Contractor shall maintain and monitor an appropriate and adequate provider network, supported by written agreements, sufficient to provide GFS services under this Contract to its Enrollees; provided that, for purposes of this Contract, Indian Health Care Providers, whether or not they have executed a written agreement with the Contractor, will be treated as in the Contractor’s provider network. Any other changes that result in the Contractor being unable to meet access including a decrease in the number or frequency of a required service, employee strike or other work stoppage related to union activities, or any changes that results in the Contractor being unable to provide timely services. The Contractor shall notify HCA ninety (90) days prior to terminating any of its Subcontracts with entities that provide direct services or entering into new subcontracts with entities that provide direct services. This notification shall occur prior to any public announcement of this change. If a Subcontract is terminated in less than ninety (90) days or a site closure occurs in less than ninety (90) days, the Contractor shall notify HCA as soon as possible and prior to a public announcement. If a subcontract is terminated or a site closes, the Contractor shall submit a plan to HCA that includes at a minimum: Notification to Ombuds services; Individual notification plan; Plan for provision of uninterrupted services; and Any information released to the media. The Contractor shall incorporate the following requirements when developing its network: The Contractor shall, in partnership with the BH-ASO, assist the state to expand community-based alternatives for crisis stabilization, such as mobile crisis or crisis residential and respite beds. The Contractor shall assist the state to expand community-based, recovery‑oriented services and research- and evidence-based practices and Promising Practices. The Contractor shall implement an adequate plan to provide Evaluation and Treatment services, including Culturally Appropriate Care, to Enrollees, which may include the development of less restrictive alternative to involuntary treatment or prevention programs reasonably calculated to reduce the demand for Evaluation and Treatment services. If the Contractor, in HCA’s sole opinion, and in conjunction with recommendations provided by the ACH, fails to maintain an adequate network of Behavioral Health providers in any contracted service area for two (2) consecutive quarters, and after notification following the first quarter, HCA reserves the right to immediately terminate the Contractor’s services for that service area. The network established under the Contract must complement and support the network of Medicaid providers established by the AH-IMC Medicaid Contract. The Contractor shall update and maintain the Contractor’s existing provider manual to include all relevant information regarding GFS services and requirements. The Contractor shall update its existing database to meet the following requirements: Includes a list of all GFS providers. Includes the providers’ names, locations, telephone numbers, GFS services offered, clinical specialty and areas of expertise. Includes a description of each provider’s language(s) spoken and if appropriate, a brief description of the provider’s skills or experiences that would support the cultural or linguistic needs of its Enrollees when provided by a provider. Indicates whether each provider has capacity to serve new patients and the limits on capacity for each provider. Updates to the provider database shall be made: no less than quarterly or whenever there is a change in the Contractor’s network that would affect adequate capacity in a service area. Contractor program staff shall be available to conduct provider searches based on office or facility location, clinical specialty, provider discipline, provider capacity, available languages and allowable fund sources (e.g., Medicaid, GFS).

Network Capacity. The Contractor shall maintain and monitor an appropriate and adequate provider network, supported by written agreements, sufficient to provide GFS services under this Contract to its Enrollees; provided that, for purposes of this Contract, Indian Health Care Providers, whether or not they have executed a written agreement with the Contractor, will be treated as in the Contractor’s provider network. Any other changes that result in the Contractor being unable to meet access including a decrease in the number or frequency of a required service, employee strike or other work stoppage related to union activities, or any changes that results in the Contractor being unable to provide timely services. The Contractor shall notify HCA ninety (90) days prior to terminating any of its Subcontracts with entities that provide direct services or entering into new subcontracts with entities that provide direct services. This notification shall occur prior to any public announcement of this change. If a Subcontract is terminated in less than ninety (90) days or a site closure occurs in less than ninety (90) days, the Contractor shall notify HCA as soon as possible and prior to a public announcement. If a subcontract is terminated or a site closes, the Contractor shall submit a plan to HCA that includes at a minimum: Notification to Ombuds services; Individual notification plan; Plan for provision of uninterrupted services; and Any information released to the media. The Contractor shall incorporate the following requirements when developing its network: The Contractor shall, in partnership with the BH-ASO, assist the state to expand community-based alternatives for crisis stabilization, such as mobile crisis or crisis residential and respite beds. The Contractor shall assist the state to expand community-based, recovery‑oriented services and research- and evidence-based practices and Promising Practicespractices. The Contractor shall implement an adequate plan to provide Evaluation and Treatment services, including Culturally Appropriate Care, services to Enrollees, which may include the development of less restrictive alternative to involuntary treatment or prevention programs reasonably calculated to reduce the demand for Evaluation and Treatment services. If the Contractor, in HCA’s sole opinion, and in conjunction with recommendations provided by the ACH, fails to maintain an adequate network of Behavioral Health providers in any contracted service area for two (2) consecutive quarters, and after notification following the first quarter, HCA reserves the right to immediately terminate the Contractor’s services for that service area. The network established under the Contract must complement and support the network of Medicaid providers established by the AH-IMC Medicaid Contract. The Contractor shall update and maintain the Contractor’s existing provider manual to include all relevant information regarding GFS services and requirements. The Contractor shall update its existing database to meet the following requirements: Includes a list of all GFS providers. Includes the providers’ names, locations, telephone numbers, GFS services offered, clinical specialty and areas of expertise. Includes a description of each provider’s language(s) spoken and if appropriate, a brief description of the provider’s skills or experiences that would support the cultural or linguistic needs of its Enrollees when provided by a provider. Indicates whether each provider has capacity to serve new patients and the limits on capacity for each provider. Updates to the provider database shall be made: no less than quarterly or whenever there is a change in the Contractor’s network that would affect adequate capacity in a service area. Contractor program staff shall be available to conduct provider searches based on office or facility location, clinical specialty, provider discipline, provider capacity, available languages and allowable fund sources (e.g., Medicaid, GFS).

Network Capacity. The Contractor shall maintain and monitor an appropriate and adequate provider network, supported by written agreements, sufficient to provide GFS services under this Contract to its Enrollees; provided that, for purposes of this Contract, Indian Health Care Providers, whether or not they have executed a written agreement with the Contractor, will be treated as in the Contractor’s provider network. Any other changes that result in the Contractor being unable to meet access including a decrease in the number or frequency of a required service, employee strike or other work stoppage related to union activities, or any changes that results in the Contractor being unable to provide timely services. The Contractor shall notify HCA ninety (90) days prior to terminating any of its Subcontracts with entities that provide direct services or entering into new subcontracts with entities that provide direct services. This notification shall occur prior to any public announcement of this change. If a Subcontract is terminated in less than ninety (90) days or a site closure occurs in less than ninety (90) days, the Contractor shall notify HCA as soon as possible and prior to a public announcement. If a subcontract is terminated or a site closes, the Contractor shall submit a plan to HCA that includes at a minimum: Notification to Ombuds services; Individual notification plan; Plan for provision of uninterrupted services; and Any information released to the media. The Contractor shall incorporate the following requirements when developing its network: The Contractor shall, in partnership with the BH-ASO, assist the state to expand community-based alternatives for crisis stabilization, such as mobile crisis or crisis residential and respite beds. The Contractor shall assist the state to expand community-based, recovery‑oriented services and research- and evidence-based practices and Promising Practicespractices. The Contractor shall implement an adequate plan to provide Evaluation and Treatment services, including Culturally Appropriate Care, services to Enrollees, which may include the development of less restrictive alternative to involuntary treatment or prevention programs reasonably calculated to reduce the demand for Evaluation and Treatment services. If the Contractor, in HCA’s sole opinion, and in conjunction with recommendations provided by the ACH, fails to maintain an adequate network of Behavioral Health providers in any contracted service area for two (2) consecutive quarters, and after notification following the first quarter, HCA reserves the right to immediately terminate the Contractor’s services for that service area. The network established under the Contract must complement and support the network of Medicaid providers established by the AH-IMC IAHFC Medicaid Contract. The Contractor shall update and maintain the Contractor’s existing provider manual to include all relevant information regarding GFS services and requirements. The Contractor shall update its existing database to meet the following requirements: Includes a list of all GFS providers. Includes the providers’ names, locations, telephone numbers, GFS services offered, clinical specialty and areas of expertise. Includes a description of each provider’s language(s) spoken and if appropriate, a brief description of the provider’s skills or experiences that would support the cultural or linguistic needs of its Enrollees when provided by a provider. Indicates whether each provider has capacity to serve new patients and the limits on capacity for each provider. Updates to the provider database shall be made: no less than quarterly or whenever there is a change in the Contractor’s network that would affect adequate capacity in a service area. Contractor program staff shall be available to conduct provider searches based on office or facility location, clinical specialty, provider discipline, provider capacity, available languages and allowable fund sources (e.g., Medicaid, GFS).