58-17F-5. Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.
125 words·~1 min read·
/sd/title-58/chapter-58-17/58-17f-5·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A health carrier providing a managed care plan shall maintain a network that is sufficient in numbers and types of providers to assure that all services to covered persons will be accessible without unreasonable delay. In the case of emergency services, covered persons shall have access twenty-four hours a day, seven days a week. Sufficiency shall be determined in accordance with the requirements of this section, and may be established by reference to any reasonable criteria used by the carrier, including: provider-covered person ratios by specialty; primary care provider-covered person ratios; geographic accessibility; waiting times for appointments with participating providers; hours of operation; and the volume of technological and specialty services available to serve the needs of covered persons requiring technologically advanced or specialty care.