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CHAPTER 58-17F

NETWORK ADEQUACY STANDARDS

58-17F-1      Definitions.
58-17F-2      Health benefit plan defined.
58-17F-3      Medical director required for managed care plans.
58-17F-4      Health carrier to provide written information to prospective enrollees--Specific information required.
58-17F-5      Health carrier to maintain provider network sufficient to assure services without unreasonable delay--Emergency services--Determination of sufficiency.
58-17F-6      Where provider network is insufficient, covered benefit to be made available at no greater cost.
58-17F-7      Health carrier to ensure provider proximity to covered persons.
58-17F-8      Health carrier to monitor provider ability, capacity, and authority--Financial capability to be monitored in capitated plans.
58-17F-9      Factors to consider in determining network adequacy.
58-17F-10      Access plan required for managed care plans--Annual update--Contents--Exemptions for discounted fee-for-service networks.
58-17F-11      Requirements for health carrier and providers in managed care plans.
58-17F-12      Provisions governing contractual arrangements between health carriers and intermediaries.
58-17F-13      Sample contract forms to be filed with director--Material changes to be submitted--Certain changes not material--Director's inaction within certain time deemed approval--Contract copies to be provided upon request.
58-17F-14      Contract does not relieve health carrier of liability.
58-17F-15      Remedies available to director against health carrier found not in compliance.
58-17F-16      Managed care contractor to register with director.
58-17F-17      Filing changes in registration information.
58-17F-18      Request for information from managed care contractor.
58-17F-19      Activities of nonregistered managed care contractor prohibited.
58-17F-20      Registration fee for managed care contractor.
58-17F-21      Promulgation of rules.


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