Chapter 17F - Network Adequacy Standards

Chapter 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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