Listed by State | Listed by Chapter & Subject
Chapter 1. Enrollment Chapter 2. Coverage and Benefits Chapter 3. Service Duties Chapter 4. Public Health and Social Service Agency Relationships Chapter 5. Quality Assurance, Data, and Reporting Chapter 6. Business Terms and Relationships Chapter 7. Payment
Table 1.1 Managed Care Enrolled Population Table 1.2 Enrollment Procedure Table 1.3 Auto-enrollment Procedure Table 1.4 Special Enrollment Procedures Table 1.5 Information for Enrollees on Coverage Rules and Provider Participation Table 1.6 Information for Enrollees on Plan Policies and Procedures Table 1.7 Plan Disenrollment of Members
Table 2.1 General Services Table 2.2 Mental Health and Substance Abuse Duties Table 2.3 Reproductive Health Services Table 2.4 EPSDT Services Table 2.5 Communicable Disease Services Table 2.6 Urgent Care and Emergency Care Services Table 2.7 Medical Necessity Standards Table 2.8 Services in Treatment Plans of Other Agencies and Court Orders
Table 3.1 Provider Network Composition Table 3.1.1 Provider Coordination and Standards Table 3.2 Plan Service Area Standards Table 3.3 Selection and Assignment of Primary Care Providers Table 3.4 Self-referrals to Selected Providers Table 3.5 Utilization Review and Prior Authorization Table 3.6 Translation Services and Cultural Competence Table 3.7 Access Time Standards Table 3.8 Geographic Access Standards Table 3.9 Drug Formularies Table 3.10 Anti-discrimination provisions
Table 4.1 Relationships with Other Public Agencies Table 4.2 Population-based services and reporting
Table 5.1 Quality Assurance Table 5.2 General Data Reporting Table 5.3 Mental Health and Substance Abuse Data Reporting Table 5.4 Maternal and Child Health Data Reporting
Table 6.1 General Qualifications and Requirements Table 6.2 Beneficiary Grievance Procedures Table 6.3 Network Provider/Plan Relationship Table 6.4 Sanctions
Table 7.1 Plan Payment Terms Table 7.2 Provider Payment Terms
