Each carrier shall establish performance targets for member accessibility to primary and specialty care physician services and hospital-based services. Carriers shall also establish similar performance targets for health care services provided by providers who are not physicians. Carriers shall establish written policies and performance targets that address the following:

(1)           The proximity of network providers, as measured by such means as driving distance or time a member must travel to obtain primary care, specialty care, and hospital services, taking into account local variations in the supply of providers, and geographic considerations.

(2)           The availability to provide emergency services on a 24-hour, 7 day per week basis.

(3)           Emergency provisions within and outside of the service area.

(4)           The average or expected waiting time for urgent, routine, and specialist appointments.


History Note:        Authority G.S. 58-2-40(1); 58-65-1; 58-65-25; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150;

Eff. October 1, 1996;

Readopted Eff. June 1, 2018.