other plan requirements
Melissa Lacy
Created on May 15, 2023
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Transcript
Other Plan Requirements
NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT)
Beneficiary Protections
Network Adequacy Requirements
Standard Plan members must have access to care management to address medical and nonmedical drivers of health care
Team-based, person-centered approach to manage patients’ medical, social, and behavioral conditions
Local care management preferred (in site of care, home, or community that is face-to-face)
Plans must meet NCDHHS’ network adequacy standards: Maximum Distance to Care Maximum Waiting time for Care Standards for Primary care and Specialists
Out-of-network care must be covered if plan can't timely provide in-network care
Provider directory must be current
Provide NEMT appropriate for the member to the nearest enrolled medical provider
Develop a network of NEMT providers
Department approves all marketing materials and plans cannot engage in direct solicitations.
Plans must provide language assistance services, including interpretation and translation
Grievance, appeal and state fair hearing procedures,
Care Management
Provide travel-related expenses including: Lodging, food, parking fees/tolls, transportation vouchers