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
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.