58-17F NETWORK ADEQUACY STANDARDS
NETWORK ADEQUACY STANDARDS
Health benefit plan defined.
Medical director required for managed care plans.
Health carrier to provide written information to prospective enrollees--Specific
Health carrier to maintain provider network sufficient to assure services without
unreasonable delay--Emergency services--Determination of sufficiency.
Where provider network is insufficient, covered benefit to be made available at no
Health carrier to ensure provider proximity to covered persons.
Health carrier to monitor provider ability, capacity, and authority--Financial
capability to be monitored in capitated plans.
Factors to consider in determining network adequacy.
Access plan required for managed care plans--Annual update--Contents--Exemptions
for discounted fee-for-service networks.
Requirements for health carrier and providers in managed care plans.
Provisions governing contractual arrangements between health carriers and
Sample contract forms to be filed with director--Material changes to be submitted--Certain changes not material--Director's inaction within certain time deemed
approval--Contract copies to be provided upon request.
Contract does not relieve health carrier of liability.
Remedies available to director against health carrier found not in compliance.
Managed care contractor to register with director.
Filing changes in registration information.
Request for information from managed care contractor.
Activities of nonregistered managed care contractor prohibited.
Registration fee for managed care contractor.
Promulgation of rules.