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