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 1 - Time and Distance Standards. (B) The Contractor shall ensure that Enrollees have access to the following types of providers within the time and distance standards. Provider or Facility Type Standard Primary Care 90% of Enrollees must have access within 10 miles or 15 minutes OB/GYN 90% of Enrollees must have access within 10 miles or 15 minutes Specialist 90% of Enrollees must have access within 30 miles or 45 minutes Hospital 90% of Enrollees must have access within 30 miles or 45 minutes Pharmacy 90% of Enrollees must have access within 10 miles or 15 minutes Behavioral health (mental health and substance use disorder) 90% of Enrollees must have access within 10 miles or 15 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 Enrollee access as described in Table 1 - Time and Distance Standards. (B) The Contractor shall ensure that Enrollees have access to the following types of providers Providers within the time and distance standards. Table 1 - Time and Distance Standards Provider or Facility facility Type Standard Primary Care 90% of Enrollees must have access within 10 miles or 15 minutes OB/GYN 90% of Enrollees must have access within 10 miles or 15 minutes Specialist 90% of Enrollees must have access within 30 miles or 45 minutes Hospital 90% of Enrollees must have access within 30 miles or 45 minutes Pharmacy 90% of Enrollees must have access within 10 miles or 15 minutes Behavioral health (mental health and substance use disorder) 90% of Enrollees must have access within 10 miles or 15 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.