Common use of PROVIDER NETWORK AND ACCESS REQUIREMENTS Clause in Contracts

PROVIDER NETWORK AND ACCESS REQUIREMENTS. ‌ The County must provide medical care to its BadgerCare Plus members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus members within the area served by the County. A. Protocols/Standards to Ensure Access The County must have written protocols to ensure that members have access to screening, diagnosis and referral and appropriate treatment for those conditions and services covered under BadgerCare Plus programs. The County’s protocols must include training and information for providers in their network, in order to promote and develop provider skills in responding to the needs of persons with limited English proficiency, mental, physical and developmental disabilities. Training should include clinical and communication issues and the role of care coordinators. For members with special health care needs, where a course of treatment or regular case monitoring is needed, the County must have mechanisms in place to allow members to directly access a specialist, as appropriate, for the member’s condition and identified needs. B. Written Standards for Accessibility of Care

PROVIDER NETWORK AND ACCESS REQUIREMENTS. ‌ The County must provide medical care to its BadgerCare Plus members that are accessible to them, in terms of timeliness, amount, duration, and scope, as those services to non-enrolled BadgerCare Plus members within the area served by the County. A. Protocols/Standards to Ensure Access The County must have written protocols to ensure that members have access to screening, diagnosis and referral and appropriate treatment for those conditions and services covered under BadgerCare Plus programs. The County’s protocols must include training and information for providers in their network, in order to promote and develop provider skills in responding to the needs of persons with limited English proficiency, mental, physical and developmental disabilities. Training should include clinical and communication issues and the role of care coordinators. For members with special health care needs, where a course of treatment or regular case monitoring is needed, the County must have mechanisms in place to allow members to directly access a specialist, as appropriate, for the member’s condition and identified needs. B. Written Standards for Accessibility of Care