SECTION .0300 ‑ PROVIDER ACCESSIBILITY AND AVAILABILITY

 

11 NCAC 20 .0301             PROVIDER AVAILABILITY STANDARDS

Each network plan carrier shall develop a methodology to determine the size and adequacy of the provider network necessary to serve the members.  The methodology shall provide for the development of performance targets that shall address the following:

(1)           The number and type of primary care physicians, specialty care providers, hospitals, and other provider facilities, as defined by the carrier.

(2)           A method to determine when the addition of providers to the network will be necessary based on increases in the membership of the network plan carrier.

(3)           A method for arranging or providing health care services outside of the service area when providers are not available in the area.

 

History Note:        Authority G.S. 58-2-40(1); 58-50-55(b); 58-65-1; 58-65-25; 58-65-140; 58-67-10; 58-67-20;

58-67-35; 58-67-65; 58-67-140; 58-67-150;

Eff. October 1, 1996.