Except as provided in §C of this regulation, an MCO shall develop and maintain a provider network that meets the following time and distance standards:
For adult and pediatric primary care, pharmacy, diagnostic laboratory and x-ray, and gynecology:
In urban areas, within 15 minutes or 10 miles;
In suburban areas, within 30 minutes or 20 miles; and
In rural areas, within 40 minutes or 30 miles;
For prenatal care, as defined in §B of this regulation:
In urban areas, within 15 minutes or 10 miles;
In suburban areas, within 30 minutes or 20 miles; and
In rural areas, within 90 minutes or 75 miles;
For acute inpatient hospitals:
In urban areas, within 20 minutes or 10 miles;
In suburban areas, within 45 minutes or 30 miles; and
In rural areas, within 75 minutes or 60 miles;
For core specialty types, as defined in Regulation .05-1A(2)(b) of this chapter:
In urban areas, within 30 minutes or 15 miles;
In suburban areas, within 60 minutes or 45 miles; and
In rural areas, within 90 minutes or 75 miles;
For major specialty types, as defined in Regulation .05-1A(2)(c) of this chapter:
In urban areas, within 30 minutes or 15 miles;
In suburban areas, within 80 minutes or 60 miles; and
In rural areas, within 110 minutes or 90 miles; and
For pediatric subspecialty types, as defined in Regulation .05-1A(2)(d) of this chapter:
In urban areas, within 30 minutes or 15 miles;
In suburban areas, within 80 minutes or 60 miles; and
In rural areas, within 250 minutes or 200 miles.
Prenatal Care Providers. For the purposes of provider network adequacy, prenatal care providers may include, but are not limited to:
Obstetricians;
Certified nurse midwives; and
Family practitioners who provide prenatal care and perform deliveries.
If an MCO can otherwise demonstrate to the Department's satisfaction the adequacy of its provider network notwithstanding its inability to meet the requirements of §A of this regulation, the Department may, in its discretion, approve the network if special circumstances exist which, considered along with the overall strength of the MCO's network, establish that the Department's approval of the network will enhance recipients' overall access to quality health care services in the area to be served.
Geographical Access: Local Access Areas.
For purposes of this regulation:
Urban enrollment area includes Baltimore City;
Rural enrollment counties include:
Allegany;
Calvert;
Caroline;
Cecil;
Charles;
Dorchester;
Frederick;
Garrett;
Kent;
Queen Anne's;
Saint Mary's;
Somerset;
Talbot;
Washington;
Wicomico; and
Worcester; and
Suburban enrollment counties include:
Baltimore County;
Anne Arundel;
Carroll;
Harford;
Howard;
Montgomery; and
Prince George’s.