Reference - Network Adequacy and Timely Access

Reference

  • 42 Code of Federal Regulations (C.F.R.) §438.3(l) Standard Contract Requirements 
  • 42 Code of Federal Regulations (C.F.R.) §438.10(e)(2) Information requirements 
  • 42 Code of Federal Regulations (C.F.R.) §438.14(b)(1)(5) Requirements that apply to MCO, PIHP, PAHP, PCCM, and PCCM entity contracts involving Indians, Indian health care providers (IHCPs), and Indian managed care entities (IMCEs) 
  • 42 Code of Federal Regulations (C.F.R.) § 438.68 Network adequacy standards 
  • 42 Code of Federal Regulations (C.F.R.) §438.114 Emergency and post stabilization services
  • 42 Code of Federal Regulations (C.F.R.) § 438.206 Availability of services
  • 42 Code of Federal Regulations (C.F.R.) § 438.207(a)-(b)(1)Assurances of adequate capacity and services 
  • 42 Code of Federal Regulations (C.F.R.) §438.208 Coordination and continuity of care 
  • 42 Code of Federal Regulations (C.F.R.) §438.210(a)(1)-(5) Coverage and authorization of services 
  • 42 Code of Federal Regulations (C.F.R.) §438.330(d)(ii) Quality assessment and performance improvement program 
  • 42 Code of Federal Regulations (C.F.R.) §438.400(b)(4) Statutory basis, definitions, and applicability
  • 42 Code of Federal Regulations (C.F.R.) §438.404 Timely and adequate notice of adverse benefit determination 
  • 42 Code of Federal Regulations (C.F.R.) § 438.910 Parity requirements for financial requirements and treatment limitations 
  • 45 Code of Federal Regulations (C.F.R.) §96.126(b)(2) Capacity of treatment for intravenous substance abusers 
  • 9 California Code of Regulations (CCR) §1810.253 Urgent Condition 
  • 9 California Code of Regulations (CCR) §1810.345 Scope of Covered Specialty Mental Health Services 
  • 9 California Code of Regulations (CCR) §1810.405 Access Standards for Specialty Mental Health Services
  • 9 California Code of Regulations (CCR) §1810.440(a)(6) MHP Quality Management Programs
  • 9 California Code of Regulations (CCR) §1830.210 Medical Necessity Criteria for MHP Reimbursement for Specialty Mental Health Services for Eligible Beneficiaries Under 21 Years of Age 
  • 9 California Code of Regulations (CCR) §1830.220 Authorization of Out-of-Plan Services 
  • 9 California Code of Regulations (CCR) §1830.225. Initial Selection and Change of Person Providing Services 
  • 28 California Code of Regulations (CCR) §1300.67.2.2 Timely Access to Non-Emergency Health Care Services 
  • Assembly Bill 205 (Chapter 738, Statutes of 2017)/Senate Bill 171 Medi-Cal: Medi-Cal managed care plans 
  • MHSUDS Information Notice No.: 18-011 Federal Network Adequacy Standards for Mental Health Plans (MHPS) and Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilot Counties 
  • California Department of Health Care Services Fiscal Year 13-18 Contract, Exhibit A
  • County of Santa Clara Behavioral Health Services Department (BHSD) Timely Access policy (replaces 412-404 Service Access and ODS Waiver policies 2, 3, and 4)

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