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.  Written policies and performance targets shall address the following:

(1)           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, seven 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); 58-50-55(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.