other plan requirements

Provide travel-related expenses including: Lodging, food, parking fees/tolls, transportation vouchers

Care Management

Grievance, appeal and state fair hearing procedures,

Plans must provide language assistance services, including interpretation and translation

Department approves all marketing materials and plans cannot engage in direct solicitations.

Develop a network of NEMT providers

Provide NEMT appropriate for the member to the nearest enrolled medical provider

Provider directory must be current

Out-of-network care must be covered if plan can't timely provide in-network care

Plans must meet NCDHHS’ network adequacy standards: Maximum Distance to Care Maximum Waiting time for Care Standards for Primary care and Specialists

Local care management preferred (in site of care, home, or community that is face-to-face)

Team-based, person-centered approach to manage patients’ medical, social, and behavioral conditions

Standard Plan members must have access to care management to address medical and nonmedical drivers of health care

Network Adequacy Requirements

Beneficiary Protections

NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT)

Other Plan Requirements