31.10.34.04

.04 Provider Panel Sufficiency.

A. A carrier shall maintain a provider panel that is sufficient in numbers and types of available providers to meet the health care needs of enrollees.

B. Standards to meet the health care needs of enrollees shall be determined in accordance with the requirements of this chapter, and may be established by reference to any reasonable criteria used by the carrier, including but not limited to:

(1) Provider-enrollee ratios by specialty;

(2) Primary care provider-enrollee ratios;

(3) Geographic accessibility;

(4) Waiting times for appointments with providers;

(5) Hours of operation; and

(6) The volume of technological and specialty services available to serve the needs of enrollees requiring technologically advanced or specialty care.