Section .0300 ‑ Provider Accessibility And Availability

Link to law: http://reports.oah.state.nc.us/ncac/title 11 - insurance/chapter 20 - managed care health benefit plans/11 ncac 20 .0301.html
Published: 2015

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SECTION .0300 ‑ PROVIDER ACCESSIBILITY AND AVAILABILITY

 

11 NCAC 20 .0301             PROVIDER AVAILABILITY STANDARDS

Each network plan carrier shall develop a methodology to

determine the size and adequacy of the provider network necessary to serve the

members.  The methodology shall provide for the development of performance

targets that shall address the following:

(1)           The number and type of primary care physicians,

specialty care providers, hospitals, and other provider facilities, as defined

by the carrier.

(2)           A method to determine when the addition of

providers to the network will be necessary based on increases in the membership

of the network plan carrier.

(3)           A method for arranging or providing health care

services outside of the service area when providers are not available in the

area.

 

History Note:        Authority G.S. 58-2-40(1); 58-50-55(b);

58-65-1; 58-65-25; 58-65-140; 58-67-10; 58-67-20;

58-67-35; 58-67-65; 58-67-140; 58-67-150;

Eff. October 1, 1996.