3 In the UMCC section 8.1.3.2 for OT/PT/ST the This is correct. As determined through the time/distance designation for micro is more stakeholder feedback process, HHSC relied on stringent than the one for a rural county. Can the Medicare advantage standards as a basis we confirm what the time/distance requirement for state network adequacy standards. The is for OT/PT and ST in a metro, micro and rural five Medicare Advantage geographic county? According to the UMCC micro is 60 categories (Large Metro, Metro, Micro, Rural, miles and 80 minutes, while rural is 60 miles and CEAC) were consolidated into the three and 75 minutes. geographic categories outlined in the UMCC (Metro, Micro, and Rural). The standards noted in your question are consistent with 2017 Medicare Advantage . 4 Cigna HealthSpring recommends blank HHSC will consider this recommendation as we exceptions should be good for one year if there develop the exception process. As a is a county with no providers. reminder, HHSC will coordinate with MCOs to develop the exception process after the full baseline reports are completed in October 2017. 5 Will physician specialties’ be measured At this time, physician specialties” are ‘other “other for adequacy? Physician Specialties’ is not included in the standardized analysis ‘Other currently listed on the technical specifications, process. However, MCOs must ensure these but not on the specialty crosswalk. provider types meet network adequacy standards as outlined in relevant managed care contracts.
3 In the UMCC section 8.1.3.2 for OT/PT/ST the time/distance designation for micro is more stringent than the one for a rural county. Can we confirm what the time/distance requirement is for OT/PT and ST in a metro, micro and rural county? According to the UMCC micro is 60 miles and 80 minutes, while rural is 60 miles and 75 minutes. This is correct. As determined through the stakeholder feedback process, HHSC relied on the Medicare advantage standards as a basis for state network adequacy standards. The five Medicare Advantage geographic categories (Large Metro, Metro, Micro, Rural, and CEAC) were consolidated into the three geographic categories outlined in the UMCC (Metro, Micro, and Rural). The standards noted in your question are consistent with 2017 Medicare Advantage . 4 Cigna HealthSpring recommends blank exceptions should be good for one year if there is a county with no providers. HHSC will consider this recommendation as we develop the exception process. As a reminder, HHSC will coordinate with MCOs to develop the exception process after the full baseline reports are completed in October 2017. 5 Will ‘other physician specialties’ be measured for adequacy? ‘Other Physician Specialties’ is currently listed on the technical specifications, but not on the specialty crosswalk. At this time, “other physician specialties” are not included in the standardized analysis process. However, MCOs must ensure these provider types meet network adequacy standards as outlined in relevant managed care contracts.
20170626_MCO_QA.DOCX