"23. OTHER
PROVIDER STANDARDS…
The Contractor
shall ensure that a maternity care provider is designated for each pregnant
member for the duration of her pregnancy and postpartum care and that maternity
services are provided in accordance with the AMPM. The Contractor
may include in its provider network the following maternity care providers:
a.
Arizona licensed allopathic and/or osteopathic physicians who are general
practitioners or specialize in family practice or obstetrics
b.
Certified nurse midwives
c.
Licensed midwives.
Members may
choose, or be assigned, a PCP who provides obstetric care (physician or
certified nurse midwife)...
All physicians
and certified nurse midwives who perform deliveries shall have OB hospital
privileges. Licensed midwives perform deliveries only in the member’s
home. Labor and delivery services may also be provided in the member’s
home by physicians and certified nurse practitioners and certified nurse
midwives who include such services within their practice." Arizona
Contract, pages 32-33.
CT
"3.6 Geographic
Coverage
a… The
MCO shall ensure that its provider network includes access for each Member
to… Obstetric/Gynecological Providers…" Connecticut Contract, page
19.
FL
"B. Manner
Of Service Provision...
2. Minimum
Standards. Plans shall provide the following: ...
d. One birth
delivery facility licensed under Chapter 383, F.S., or a hospital with
birth delivery facilities… The delivery facility may be part of a hospital
or a freestanding facility...
g. A birthing center licensed under Chapter 383, F.S., that is accessible to low risk patients. The agency may waive, in writing, this requirement if the plan cannot reach an agreement with those centers within reasonable travel time for a rate no greater than the Medicaid rate for those centers..." Florida Contact, pages 10-11.
"6. Specialty
Coverage...
a. The
plan shall assure the availability of the following specialist, as
appropriate for both adult and pediatric members, on at least a referral
basis: ...obstetrical/gynecology (OB/GYN)..." Florida Contract, page
17.
HI
"30.410
Required Providers...
The following
is a listing of required components of the provider network...
* Other
practitioner services such as ...certified nurse midwife services…"
Hawaii RFP, page 9.
"APPENDIX B
MINIMUM PROVIDER
REQUIREMENTS
PCP Requirement:
The health
plan must have contracts with at least 1 PCP per 600 QUEST members.
PCPs may be
any of the following: …
* OB/Gyn
* Nurse
Midwives…" Hawaii RFP, Appendix B, page 1.
IL
"(o) Choice
of Physicians
The Contractor
shall afford to each Beneficiary a physician who will supervise and coordinate
his/her care, and to the extent feasible, within appropriate limits established
by the Contractor and approved by the Department, shall afford the Beneficiary
a choice of a physician...
Primary Care Providers shall have specialties in obstetrics/gynecology, general practice, pediatrics, internal medicine or family practice. In each Contracting Area, there shall be at least one Women's Health Care Provider for each 2,000 female Beneficiaries between the ages of 18 and 44, at least one physician specializing in obstetrics for each 300 pregnant female Beneficiaries and at least one pediatrician for each 2,000 Beneficiaries under age 17…The agreement must provide for the transfer of medical records and Coordination of Care between physicians." Illinois HMO Contract, page 45.
KY
"To be the eligible
applicant, Kentucky's Health Care Partnership (a.k.a. The Partnership)
must meet the following requirements: ...
•
have a Program of providers in each county who are serving a significant
portion of the current Medicaid members. This requirement applies
to each of the following provider types: ...
•
maternity care." Kentucky RFA, pages 10-11.
"A. Providers
to Be Enrolled
The
Partnership shall enroll into its Network...birthing centers…" Kentucky
RFA, Attachment V, page 43.
MT
"2.4.2
Participating Providers:...
B. Providers
Contracts Must be Extended to or Contractor Must Allow Access to: ...
The CONTRACTOR
must allow obstetricians and gynecologists to participate as PRIMARY CARE
PROVIDERS. An obstetrician or gynecologists wishing to accept designation
as a PRIMARY CARE PROVIDER must meet the same credentialling criteria as
other PRIMARY CARE PROVIDERS, as specified in accordance with appendix
2, 2.4.3 of this Attachment, and the same contracting requirements the
CONTRACTOR imposes on other PCPs." Montana Contract, page 37.
"2.5.1(C)
Obstetrical, Gynecological and Maternity Services
FAIM women
mandated to the HMO and who become pregnant are no longer FAIM and have
the choice to choose between the HMO and the PASSPORT TO HEALTH program.
If the woman chooses the PASSPORT program she may choose any provider for
the duration of the pregnancy. After the pregnancy, she becomes FAIM
again and must enroll back in the HMO. Pregnant women who choose
to remain in the HMO for their pregnancy may choose any participating provider
within the HMO panel for provision of maternity care, and may choose a
provider without prior authorization from their HMO Primary Care Provider
(PCP)." Montana Contract, page 44.
NM
"2.C.10 Local
Department of Health Offices:
2.C.10.a
The CONTRACTOR shall contract with local and district public health offices
for the provision of the following services:
2.C.10.a.i
Family planning services; and..." New Mexico Contract, page 30.
NY
"21. PARTICIPATING
PROVIDERS...
21.12
Primary Care Practitioners...
c) OB/GYN Providers
as PCPs
The Contractor,
at its option, is permitted to use OB/GYN providers as PCPs, subject to
SDOH qualifications…" New York Contract, pages 21-1-21-7.
OH
"(b) Non-PCP
Minimum Provider Network
During the
verification phase, each MCP will also be required to submit documentation
or have documentation available to verify adequate capacity of the remainder
of its provider network within the following categories: …obstetricians/gynecologists
(OB/GYNs)...
Other Specialty Types
OB/GYNs - In order to meet the minimum provider network requirement for OB/GYNs MCPs must verify during the documentation phase that they are contracting with the specified number of OB/GYNs for each service area. For the duration of the contract period, the MCP's provider network must include this minimum specified number of OB/GYNs, all of whom must have an obstetrical practice and hospital delivery privileges…" Ohio RFP, pages 24-26.
"APPENDIX L
Grant Funding
for Family Planning Services in Ohio...
The Public Health
Service Act
The Department
is one of four grantee agencies in Ohio which receives federal funds for
family planning through Title X of the Public Health Services Act. Within
the Department, the Family Planning and Women's Health Program has the
primary responsibility for carrying out the Title X funded family planning
project...
Maternal and
Child Health Block Grant
The Department
is the only agency in Ohio which receives funds through the federal Maternal
and Child Health (MCH) Block Grant...
State Family
Planning Funds
The Department
assures appropriate distribution of state funds designated by the Ohio
Legislature for provision of family planning services in Ohio...
Grantee Organizations
Planned Parenthood
of Summit, Portage, and Medina Counties...
Federation
for Community Planning, Cleveland...
Planned Parenthood
of Central Ohio...
Ohio Department
of Health…" Ohio RFP, Appendix L, pages 3-5.
OK
"2.7 Provider
Network...
2.7.2.3
Eligible Specialties
Health Plan
agrees its PCPs will be physicians in the following specialties: ...
• Obstetrics
and Gynecology…
2.7.2.6
OB/GYN Providers
Health Plan
may permit OB/GYN providers to serve as PCPs for women. If Health Plan
does not include these physicians as PCPs, it must permit pregnant members
to select an OB/GYN provider, from any in Health Plan's network, for pre-natal
care and delivery, subject to capacity limits" Oklahoma RFP, pages
32-35.
PA
"I. PROVIDER
NETWORK...
2. Network
Composition
The HMO must
establish and maintain adequate provider networks to serve all of the eligible
HealthChoices populations in geographically accessible locations within
the service area for the HealthChoices populations to be served... The
HMO shall ensure that its provider network is adequate to provide its MA
enrollees with access to quality patient care through participating professionals,
in a timely manner, and without the need to travel undue distances... The
HMO's network composition should include the following: ...
• The
HMO must ensure access to Certified Registered Midwives …" Pennsylvania
RFP, page 63-64.
RI
"2.08.02.02
Eligible Specialties
Contractor
agrees to limit its PCPs to licensed, board-certified, eligible, or trained
Medical Doctors and Doctors of Osteopathy in the following specialties:
...
- Obstetrics/Gynecology…"
Rhode Island RFP, pages 33-34.
SC
"BEST PRACTICE
EXAMPLES
FOR HEALTH
MAINTENANCE ORGANIZATIONS...
ENHANCED PRENATAL
CARE…" South Carolina Contract, Appendix B, page 1.
"Medical Services:
The major goal
of the HRCP is to direct high risk pregnant women to appropriate medical
services that are designed to enhance the patients' health. It mandates
that prenatal and intrapartum care be provided by a board certified/applied
obstetrician and that delivery take place in a level II or level III hospital…"
South Carolina Contract, Appendix B, page 2.
TX
"6.7 FAMILY
PLANNING - SPECIFIC REQUIREMENTS
6.7.1
Counseling and Education… HMO is encouraged to include a representative
cross-section of Members and family planning providers who practice in
the community in developing, planning and implementing family planning
outreach programs...
6.7.3 Provider Standards and Payment. HMO must require all subcontractors who are family planning agencies to deliver family planning services according to the TDH Family Planning Services Delivery Standards…" Texas Contract, page 40.
"6.9 PERINATAL
SERVICES...
6.9.2
HMO shall have a perinatal health care system in place that, at a minimum,
provides the following services: ...
6.9.2.5
availability and accessibility of obstetricians/gynecologists, anesthesiologists,
and neonatologists capable of dealing with complicated perinatal problems;
6.9.2.6
availability and accessibility of appropriate outpatient and inpatient
facilities capable of dealing with complicated perinatal problems…"
Texas Contract, page 44.
"7.9 OB/GYN
PROVIDERS
HMO must allow
a female Member to select an OB/GYN within its provider network or within
a limited provider network in addition to a PCP, to provide health care
services within the scope of the professional specialty practice of a properly
credentialed OB/GYN...A Member who selects an OB/GYN must be allowed direct
access to the health care services of the OB/GYN without a referral by
the woman’s PCP or a prior authorization or precertification from HMO.
HMO must allow Members to change OB/GYNs up to four times per year…"
Texas Contract, page 67.
WV
"3.9 Family
Planning Access and Confidentiality...
The Managed
Care Plan shall make a reasonable effort to subcontract with all local
family planning clinics and providers, including those funded by Title
X of the Public Health Services Act, and shall reimburse providers for
all family planning services regardless of whether they are rendered by
a participating or non-participating provider..." West Virginia Contract,
page 12.