58-17F NETWORK ADEQUACY STANDARDS
CHAPTER 58-17F
NETWORK ADEQUACY STANDARDS
58-17F-1
Definitions.
58-17F-2
Health benefit plan defined.
58-17F-3
Medical director required for managed care plans.
58-17F-4
Health carrier to provide written information to prospective enrollees--Specific
information required.
58-17F-5
Health carrier to maintain provider network sufficient to assure services without
unreasonable delay--Emergency services--Determination of sufficiency.
58-17F-6
Where provider network is insufficient, covered benefit to be made available at no
greater cost.
58-17F-7
Health carrier to ensure provider proximity to covered persons.
58-17F-8
Health carrier to monitor provider ability, capacity, and authority--Financial
capability to be monitored in capitated plans.
58-17F-9
Factors to consider in determining network adequacy.
58-17F-10
Access plan required for managed care plans--Annual update--Contents--Exemptions
for discounted fee-for-service networks.
58-17F-11
Requirements for health carrier and providers in managed care plans.
58-17F-12
Provisions governing contractual arrangements between health carriers and
intermediaries.
58-17F-13
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.
58-17F-14
Contract does not relieve health carrier of liability.
58-17F-15
Remedies available to director against health carrier found not in compliance.
58-17F-16
Managed care contractor to register with director.
58-17F-17
Filing changes in registration information.
58-17F-18
Request for information from managed care contractor.
58-17F-19
Activities of nonregistered managed care contractor prohibited.
58-17F-20
Registration fee for managed care contractor.
58-17F-21
Promulgation of rules.
Title 58