Section 98-5.9 MCO reporting on network adequacy and access
Effective Date
Section 98-5.9 MCO reporting on network adequacy and access.
(a) By December 31, 2026 and annually thereafter, each MCO shall submit to the commissioner a written certification in a form prescribed by the commissioner and signed by an officer of the MCO that confirms the following:
(1) the MCO has an access plan as required by section 98-5.8 of this Part and that such access plan is available upon the commissioner’s request;
(2) the MCO has sufficient participating providers in each network used by the MCO to meet the appointment wait time standards as required by section 98-5.5 of this Part, or in instances where there are not sufficient participating providers to meet the appointment wait time standards as required by section 98- 5.5 of this part, that the MCO allows enrollees to obtain behavioral health services from non-participating providers pursuant to section 98-5.6 of this Part;
(3) the number of access complaints received and a description of how the access complaints were resolved, including the behavioral health services requested, the geographic area of the State where the services were requested, the number of approved referrals to non-participating providers made during the prior 12 months pursuant to section 98-5.6 of this Part; and the number of referrals that the MCO did not approve and the reasons why the MCO did not approve the referrals; and
(4) the MCO has performed the provider directory verification required by section 98-5.7 of this Part.