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 patient access. The standards will be different for Frontier, Rural and Urban areas of the State. Wasatch Front Urban, Rural and Frontier areas of Utah are listed in the following table. Table 1 – County Designation Cache Carbon Beaver Davis Iron Box Elder Salt Lake ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Utah Sanpete Duchesne ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ Summit Garfield Wasatch Grand Washington Juab ▇▇▇▇ ▇▇▇▇▇▇▇ Piute Rich San ▇▇▇▇ Tooele Uintah ▇▇▇▇▇ (B) The Contractor shall ensure that Enrollees have access to the following types of providers within the time and distance standards. Table 2 – Time and Distance Standards Primary Care – Adult 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Primary Care – Pediatric 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes OB/GYN 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Specialist – Adult 90% of members must have access 90% of members must have access within 80 90% of members must have access within 110 within 30 miles or 45 minutes miles or 100 minutes miles or 125 minutes Specialist – Pediatric 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 80 miles or 100 minutes 90% of members must have access within 110 miles or 125 minutes Hospital 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 60 miles or 80 minutes 90% of members must have access within 100 miles or 110 minutes Pharmacy 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes (C) If the Contractor is unable to meet the network adequacy standards described in this Article 5.1.2, 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 the following: (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 patient access. The standards will be different for Frontier, Rural and Wasatch Front Urban areas of the State. Wasatch Front Urban, Rural and Frontier areas of Utah are listed in the following table. Table 1 – County Designation Cache Carbon Beaver Davis Iron Box Elder Salt Lake ▇Wasatch Front Urban Counties Non Wasatch Front Rural Counties Non Wasatch Front Frontier Counties ▇▇▇▇▇ ▇▇▇▇▇▇▇ Utah Sanpete Duchesne Box ▇▇▇▇▇ ▇▇▇▇▇▇ Salt Lake Cache ▇▇▇▇▇▇▇ Utah Carbon Duchesne ▇▇▇▇▇ Iron ▇▇▇▇▇ ▇▇▇▇▇▇ Garfield Sanpete Grand ▇▇▇▇▇▇ Juab Summit Garfield ▇▇▇▇ Tooele ▇▇▇▇▇▇▇ Uintah Piute Wasatch Grand Washington Juab ▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ Piute Rich San ▇▇▇▇ Tooele Uintah ▇▇▇▇▇ (B) The Contractor shall ensure that Enrollees members have access to the following types of providers within the time and distance standards. Table 2 – Time and Distance Standards Provider or facility type Wasatch Front Urban Counties Non Wasatch Front Rural Counties Non Wasatch Front Frontier Counties Primary Care – Adult Pediatric 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 20 miles or 30 minutes 75% of members must have access within 30 miles or 60 minutes OB/GYN 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 40 miles or 75 minutes 75% of members must have access within 60 miles or 90 minutes Specialist 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 40 miles or 75 minutes 75% of members must have access within 60 miles or 90 minutes Hospital 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 40 miles 75% of members must have access within 60 miles or 90 minutes or 75 minutes Pharmacy 95% of members 85% of 75% of members must must have access members must have access within 30 within 10 miles or have access miles or 60 minutes 20 minutes within 20 miles or 30 minutes Behavioral health (mental health and substance use disorder) 90% of members must have access within 10 miles or 15 20 minutes 9080% of members must have access within 35 20 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Primary Care – Pediatric 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes OB/GYN 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Specialist – Adult 90% of members must have access 90% of members must have access within 80 90% of members must have access within 110 within 30 miles or 45 minutes miles or 100 minutes miles or 125 minutes Specialist – Pediatric 9075% of members must have access within 30 miles or 45 60 minutes 90% of members must have access within 80 miles or 100 minutes 90% of members must have access within 110 miles or 125 minutes Hospital 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 60 miles or 80 minutes 90% of members must have access within 100 miles or 110 minutes Pharmacy 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes (C) If the Contractor is unable to meet the network adequacy standards described in this Article 5.1.2, 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 the following: (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 patient Enrollee access. The standards will be different for Frontier, Rural and Wasatch Front Urban areas of the State. Wasatch Front Urban, Rural and Frontier areas of Utah are listed in the following table. Table 1 – - County Designation Urban Counties Rural Counties Frontier Counties Cache Carbon Beaver Davis Iron ▇▇▇▇▇▇ ▇▇▇▇▇ lron Box Elder Salt Lake ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Utah Sanpete Duchesne ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ Summit Garfield Wasatch Grand Washington Juab ▇▇▇▇ ▇▇▇▇▇▇▇ Piute Rich San ▇▇▇▇ Tooele Uintah ▇▇▇▇▇ (B) The Contractor shall ensure that Enrollees have access to the following types of providers Network Providers within the time and distance standards. Table 2 – Time and Distance Standards - Provider or facility type Wasatch Front Urban Counties Non Wasatch Front Rural Counties Non Wasatch Front Frontier Counties Primary Care – Adult - Pediatric 95% of members must have access 85% of members must have access 75% of members must have access within 10 miles or 20 minutes within 20 miles or 30 minutes within 30 miles or 60 minutes OB/GYN 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 40 miles or 75 minutes 75% of members must have access within 60 miles or 90 minutes Specialist 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 40 miles or 75 minutes 75% of members must have access within 60 miles or 90 minutes Hospital 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 40 miles or 75 minutes 75% of members must have access within 60 miles or 90 minutes Pharmacy 95% of members must have access within 10 miles or 20 minutes 85% of members must have access within 20 miles or 30 minutes 75% of members must have access within 30 miles or 60 minutes Behavioral health (mental health and substance use disorder) 90% of members must have access within 10 miles or 15 20 minutes 9080% of members must have access within 35 20 miles or 45 30 minutes 90% of members must have access within 60 miles or 70 minutes Primary Care – Pediatric 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes OB/GYN 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Specialist – Adult 90% of members must have access 90% of members must have access within 80 90% of members must have access within 110 within 30 miles or 45 minutes miles or 100 minutes miles or 125 minutes Specialist – Pediatric 9075% of members must have access within 30 miles or 45 minutes 90% of members must have access within 80 miles or 100 minutes 90% of members must have access within 110 miles or 125 minutes Hospital 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 60 miles or 80 minutes 90% of members must have access within 100 miles or 110 minutes Pharmacy 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes (C) If lf the Contractor is unable to meet the network adequacy standards described in Article 5.1.2 of this Article 5.1.2attachment, 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 the followinginclude: (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 '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 patient access. The standards will be different for Frontier, Rural and Urban areas of the State. Wasatch Front Urban, Rural and Frontier areas of Utah are listed in the following table. Table 1 – County Designation Cache Carbon Beaver Davis Iron Box Elder Salt Lake ▇Summit Tooele ▇▇▇▇▇ ▇▇▇▇▇▇▇ Wasatch Salt Lake Utah Sanpete Duchesne ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ Summit Garfield Wasatch Grand Washington Juab ▇▇▇▇ ▇▇▇▇▇▇▇ Piute Rich San ▇▇▇▇ Tooele Uintah ▇▇▇▇▇ (B) The Per CMS regulations, the Contractor shall ensure that Enrollees have access to the following types of providers within the time and distance standards. Table 2 – Time and Distance Standards Primary Care – Adult 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Primary Care – Pediatric 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes OB/GYN 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Specialist – Adult 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 80 miles or 100 minutes 90% of members must have access within 110 within 30 miles or 45 minutes miles or 100 minutes miles or 125 minutes Specialist – Pediatric 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 80 miles or 100 minutes 90% of members must have access within 110 miles or 125 minutes Hospital 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 60 miles or 80 minutes 90% of members must have access within 100 miles or 110 minutes Pharmacy 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes (C) In light of the specialized services performed on-site at the HOME clinic, the Contractor is exempt from the time and distance standards when performing these on-site services. When a service is required to be performed off-site of the HOME clinic, the Contractor shall ensure the network adequacy standards described in 5.1.2 are met. (D) If the Contractor is unable to meet the network adequacy standards described in this Article 5.1.2, 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 the following: (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 patient Enrollee access. The standards will be different for Frontier, Rural and Urban areas of the State. Wasatch Front Urban, Rural and Frontier areas of Utah are listed in the following tableTable 2 - Time and Distance Standards. Table 1 – - County Designation Urban Counties Rural Counties Frontier Counties Cache Carbon Beaver Davis Iron Box Elder Salt Lake ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ Utah Sanpete Duchesne ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ Summit Garfield Wasatch Grand Washington Juab ▇▇▇▇ ▇▇▇▇▇▇▇ Piute Rich San ▇▇▇▇ Tooele Uintah ▇▇▇▇▇ (B) The Contractor shall ensure that Enrollees have access to the following types of providers Providers within the time and distance standards. Table 2 – - Time and Distance Standards Provider or facility Type Urban Counties Rural Counties Frontier Counties Primary Care – - Adult 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Primary Care – - Pediatric 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes OB/GYN 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes Specialist – - Adult 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 80 miles or 100 minutes 90% of members must have access within 110 within 30 miles or 45 minutes miles or 100 minutes miles or 125 minutes Specialist – - Pediatric 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 80 miles or 100 minutes 90% of members must have access within 110 miles or 125 minutes Hospital 90% of members must have access within 30 miles or 45 minutes 90% of members must have access within 60 miles or 80 minutes 90% of members must have access within 100 miles or 110 minutes Pharmacy 90% of members must have access within 10 miles or 15 minutes 90% of members must have access within 35 miles or 45 minutes 90% of members must have access within 60 miles or 70 minutes (C) If the Contractor is unable to meet the network adequacy standards described in Article 5.1.2 of this Article 5.1.2attachment, 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 the followinginclude: (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.