Plain Text Law

Regulation .05-1 Access Standards: Specialty Provider Network.

Regulation .05-1 Access Standards: Specialty Provider Network.Copy Citation

A.
Standards and Regions.
(1)
The Department shall review an MCOs specialty provider network for MCOs overall network as defined in this regulation.
(2)
Overall Network Standards.
(a)
An MCO shall meet either the time or distance standard set forth in Regulation .06A of this chapter for core, major, and pediatric specialties.
(b)
The nine core specialties are:
(i)
Cardiology;
(ii)
Otolaryngology (ENT);
(iii)
Gastroenterology;
(iv)
Neurology;
(v)
Oncology;
(vi)
Ophthalmology;
(vii)
Orthopedics;
(viii)
Surgery; and
(ix)
Urology.
(c)
The 6 major specialties are:
(i)
Allergy and immunology;
(ii)
Dermatology;
(iii)
Endocrinology;
(iv)
Infectious disease;
(v)
Nephrology; and
(vi)
Pulmonology.
(d)
The 4 pediatric subspecialties are:
(i)
Cardiology;
(ii)
Gastroenterology;
(iii)
Neurology; and
(iv)
Surgery.
B.
If the Department determines that an MCO does not meet the requirements specified in §A(2)(b)(d) of this regulation, the MCO may provide additional information to support the adequacy of the MCO's specialty network before any action is taken by the Department.
C.
If an MCO fails to meet the requirements established by this regulation, the Department may suspend the automatic assignment to the MCO of recipients who live in the affected local access area.