Common use of Time and Distance Standards Clause in Contracts

Time and Distance Standards. (A) The Contractor shall maintain provider network adequacy time and distance standards to ensure Enrollee access as described in Table 2 for adult and pediatric Covered Services. The standards vary for urban, rural and frontier counties of the State. Table 1 includes the designation of each county as urban, rural, or frontier. The Contractor shall apply the standards in Table 2 according to each of its covered county’s designation in Table 1. The Contractor shall apply the standards as applicable to adult mental health providers, adult substance use disorder providers, pediatric mental health providers and pediatric substance use disorder providers. Table 1 - County Designation Urban Counties Rural Counties Frontier Counties ▇▇▇▇▇ Cache Beaver Salt Lake Carbon Box Elder Utah Iron ▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇ Sanpete ▇▇▇▇▇ ▇▇▇▇▇▇ Garfield Summit Grand Wasatch Juab Washington ▇▇▇▇ ▇▇▇▇▇▇▇ Piute Rich San ▇▇▇▇ Tooele Uintah ▇▇▇▇▇ Table 2 - Network Adequacy Standards Urban Counties Rural Counties Frontier Counties 90% of members must 80% of members must 75% of members must have access to Network have access to Network have access to Network Providers within 10 miles Providers within 35 miles Providers within 60 miles or 15 minutes or 45 minutes or 70 minutes (B) If the Contractor is unable to meet the network adequacy standards described in Table 2 above, the Contractor may request an exception to these standards. The Department has sole discretion to allow for any exception to the network adequacy standards. A request for exception to these standards must be in writing and must include: (1) the specific exemption the Contractor is requesting; (2) the steps taken by the Contractor to comply with the network adequacy requirements before requesting the exception; and (3) a description of the Contractor’s plan to adequately provide Covered Services in the area where the exemption is requested.

Time and Distance Standards. (A) The Contractor shall maintain provider network adequacy time and distance standards to ensure Enrollee access as described in Table 2 for adult and pediatric Covered Services. The standards vary for urban, rural and frontier counties of the State. Table 1 includes the designation of each county as urban, rural, or frontier. The Contractor shall apply the standards in Table 2 according to each of its covered county’s designation in Table 1. The Contractor shall apply the standards as applicable to adult mental health providers, adult substance use disorder providers, and pediatric mental health providers and pediatric substance use disorder providers. Table 1 - County Designation Urban Counties Rural Counties Frontier Counties ▇▇▇▇▇ Cache Beaver Salt Lake Carbon Box Elder Utah Iron ▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇ Sanpete ▇▇▇▇▇ ▇▇▇▇▇▇ Garfield Summit Grand Wasatch Juab Washington ▇▇▇▇ ▇▇▇▇▇▇▇ Piute Rich San ▇▇▇▇ Tooele Uintah ▇▇▇▇▇ Table 2 - Network Adequacy Standards Urban Counties Rural Counties Frontier Counties 90% of members must 80% of members must 75% of members must have access to Network have access to Network have access to Network Providers within 10 miles Providers within 35 miles Providers within 60 miles or 15 minutes or 45 minutes or 70 minutes (B) If the Contractor is unable to meet the network adequacy standards described in Table 2 above, the Contractor may request an exception to these standards. The Department has sole discretion to allow for any exception to the network adequacy standards. A request for exception to these standards must be in writing and must include: (1) the specific exemption the Contractor is requesting; (2) the steps taken by the Contractor to comply with the network adequacy requirements before requesting the exception; and (3) a description of the Contractor’s plan to adequately provide Covered Services in the area where the exemption is requested.