Non-24-Hour Diversionary Services within two calendar – days of discharge; Medication Management within 14 calendar days of – discharge; Other Outpatient Services within seven calendar days of – discharge; and Intensive Care Coordination Services within the time – frame directed by EOHHS. The Contractor shall ensure that Network Providers offer hours of operation that are no less than the hours of operation offered to commercial enrollees or MassHealth Fee-For-Service if the Provider serves only Enrollees or other Members. The Contractor may request an exception to the access standards set forth in this Section 2.9.B. by submitting a written request to EOHHS. Such request shall include alternative standards that are equal to, or better than, the usual and customary community standards for accessing care. Upon approval by EOHHS, the Contractor shall notify Enrollees in writing of such alternative access standards. The Contractor shall have a system in place to monitor and document access and appointment scheduling standards. The Contractor shall use statistically valid sampling methods for monitoring compliance with the appointment/access standards specified above in Section 2.9.B.1.and 2. and shall promptly address any access deficiencies, including but not limited to taking corrective action if there is a failure to comply by a Provider. Annually, in accordance with Appendix A, the Contractor shall evaluate and report to EOHHS Network-wide compliance with the access standards specified in Section 2.9.B.1. and 2. Availability The Contractor shall execute and maintain written contracts with Providers to ensure that Enrollees have access to ACO Covered Services within a reasonable distance and travel time from the residence, as provided below. The Contractor shall take into Enrollee’s account both walking and public transportation. Primary Care Providers The Contractor shall develop and maintain a of Primary Care Providers (PCP network) that ensures PCP coverage and availability throughout the Service Area 24 hours a day, seven days a week.
Non-24-Hour Diversionary Services – within two calendar days of discharge; Medication Management – within 14 calendar days of discharge; Other Outpatient Services – within seven calendar days of discharge; and Intensive Care Coordination Services – within the time frame directed by EOHHS. The Contractor shall ensure that Network Providers offer hours of operation that are no less than the hours of operation offered to commercial enrollees or MassHealth Fee-For-Service if the Provider serves only Enrollees or other Members. The Contractor may request an exception to the access standards set forth in this Section 2.9.B. by submitting a written request to EOHHS. Such request shall include alternative standards that are equal to, or better than, the usual and customary community standards for accessing care. Upon approval by EOHHS, the Contractor shall notify Enrollees in writing of such alternative access standards. The Contractor shall have a system in place to monitor and document access and appointment scheduling standards. The Contractor shall use statistically valid sampling methods for monitoring compliance with the appointment/access standards specified above in Section 2.9.B.1.and 2. and shall promptly address any access deficiencies, including but not limited to taking corrective action if there is a failure to comply by a Provider. Annually, in accordance with Appendix A, the Contractor shall evaluate and report to EOHHS Network-wide compliance with the access standards specified in Section 2.9.B.1. and 2. Availability The Contractor shall execute and maintain written contracts with Providers to ensure that Enrollees have access to ACO Covered Services within a reasonable distance and travel time from the Enrollee’s residence, as provided below. The Contractor shall take into account both walking and public transportation. Primary Care Providers The Contractor shall develop and maintain a of Primary Care Providers (PCP network) that ensures PCP coverage and availability throughout the Service Area 24 hours a day, seven days a week.
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