For primary care providers
NE | NY | PA "7.9.4 PCP Change in Location: If a PCP changes location, the Contractor, after considering the needs of the client, may use its judgment in determining whether the clients should be moved with the PCP or remain with a different PCP at the same location." Nebraska Contract, page 70.
"21. PCP QUALIFICATION AND PARTICIPATION REQUIREMENTS PROVIDER NETWORK AND AGREEMENTS 21.1(a) The (PCPCP/Contractor) will establish and maintain a primary care provider network with sufficient numbers of primary care providers in geographically accessible locations for the populations they serve. The network found acceptable by (the LDSS and) the SDOH is affixed as Appendix O, which is hereby made a part of this Agreement as if set forth fully herein. Information displayed therein shall conform to the form and format specified in Appendix I, which is hereby made a part of this Agreement as if set forth fully herein.
21.1(b) The (PCPCP/Contractor) will establish and maintain affiliations with a sufficient number of referred service providers in geographically accessible locations for populations they serve. The (PCPCP/Contractor) will demonstrate these affiliations through notarized provider listings of specialty physician and ancillary providers. The PCPCP/Contractor shall have signed agreements with hospitals...
(f) Distance/Travel Time for Primary Care
The (PCPCP/Contractor) will offer every Enrollee the opportunity to select from at least three PCPs within the following distance/travel time standards (by car or public transportation):
(i) Non-Metropolitan areas - 30 miles/30 minutes.(ii) Metropolitan areas - 30 minutes by public transportation.
Transport time and distance in rural areas to primary care sites and hospitals may be greater than 30 minutes/30 miles if based on the community standard for accessing care or if by beneficiary choice. Where greater, the exceptions must be justified and documented by the (PCPCP/Contractor) on the basis of community standards. Enrollees may, at their discretion, select participating PCPs located farther from their homes as long as they are able to arrange for transportation to the PCP themselves." New York Contract, pages 44-47.
"2. Provider Enrollment
The contractor must develop and implement a plan to: ...
d. Ensure availability of sufficient providers prior in Lancaster County. Sufficient providers for this Sole Source are defined as a maximum of 1,000 recipients to 1 provider, or up to a maximum of 5,000 recipients per multi-provider sites. In urban areas the PCCM must be located no more than 30 minutes traveling distance and 60 minutes traveling distance in rural areas...C. LCHP Recipients
All Plans and Materials must be prior approved by the Department.1. Recipient/Enrollment
The contractor must develop and implement a plan to: ...
d. Assist recipients in selecting a PCCM, based upon information available, including but not limited to the following:
1. PCCMs located no more than 30 minutes traveling distance from their homes in urban areas.
2. PCCMs located no more than 60 minutes traveling distance from their homes in rural areas.
3. Age, chronic illness status or special needs.e. Assign recipients to a PCCM within 5 working days in the even that no selection has been made within the 30 day time period. Assignments should be based on, but not limited to the following criteria:
(1.) PCCMs located no more than 30 minutes traveling distance from their home in urban areas.
(2.) PCCMs located no more than 60 minutes traveling distance from their home in rural areas.
(3.) Provider/patient caseload list." Pennsylvania Program Standards, Rider 2.