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 1. The County must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the County. The standards must include the following: a. Waiting times for care at facilities; b. Waiting times for appointments; c. Statement that providers’ hours of operation do not discriminate against BadgerCare Plus members; and d. Whether or not provider(s) speak the member’s language. 2. The County may not prohibit, or otherwise restrict, a health care professional acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee who is his or her patient, for the following: a. The enrollee’s health status, medical care, or treatment options, including any alternative treatment that may be self- administered. b. Any information the enrollee needs in order to decide among all relevant treatment options. c. The risks, benefits, and consequences of treatment or non- treatment. d. The enrollee’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions. These minimum requirements shall not release the County from the requirement to provide or arrange for the provision of any medically necessary covered service required by its members. The County must take corrective action if its standards are not met.
Appears in 1 contract
Sources: Contract for Services
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
1. The County must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the County. The standards must include the following:
a. Waiting times for care at facilities;
b. Waiting times for appointments;
c. Statement that providers’ hours of operation do not discriminate against BadgerCare Plus members; and
d. Whether or not provider(s) speak the member’s language.
2. The County may not prohibit, or otherwise restrict, a health care professional acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee who is his or her patient, for the following:
a. The enrollee’s health status, medical care, or treatment options, including any alternative treatment that may be self- administered.
b. Any information the enrollee needs in order to decide among all relevant treatment options.
c. The risks, benefits, and consequences of treatment or non- treatment.
d. The enrollee’s right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions. These minimum requirements shall not release the County from the requirement to provide or arrange for the provision of any medically necessary covered service required by its members. The County must take corrective action if its standards are not met.
Appears in 1 contract
Sources: Contract for Services