31.10.44.09

.09 Network Adequacy Access Plan Executive Summary Form.

A. For each provider panel used by a carrier for a health benefit plan, the carrier shall provide the network sufficiency results for the health benefit plan service area as follows:

(1) Travel Distance Standards.

(a) For each provider type listed in Regulation .04, list the percentage of enrollees for which the carrier met the travel distance standards, in the following format:

  Urban Area Suburban Area Rural Area
Primary Care Provider      
Specialty Provider      

(b) List the total number of certified registered nurse practitioners counted as a primary care provider.

(c) List the total percentage of primary care providers who are certified registered nurse practitioners.

(d) List the total number of essential community providers in the carrier’s network.

(e) List the total percentage of essential community providers available in the health benefit plan’s service area that are participating providers.

(2) Appointment Waiting Time Standards.

(a) For each appointment type listed in Regulation .05, list the percentage of enrollees for which the carrier met the appointment wait time standards, in the following format:

Appointment Waiting Time Standard Results
Urgent care — within 72 hours  
Routine primary care — within 15 calendar days  
Preventative Visit/Well Visit — within 30 calendar days  
Non-urgent specialty care — within 30 calendar days  
Non-urgent ancillary services — within 30 calendar days  
Non-urgent behavioral health/substance use disorder services — within 10 calendar days  

(b) List the total percentage of telehealth appointments counted as part of the appointment waiting time standard results.

(3) Provider-to-Enrollee Ratio Standards.

(a) This subsection does not apply to Group Model HMO health benefit plans.

(b) For all other carriers, list whether the percentage of provider-to-enrollee ratios meet the provider-to-enrollee ratio standards listed in Regulation .06 of this chapter for each of the following categories:

(i) 1,200 enrollees for primary care;

(ii) 2,000 enrollees for pediatric care;

(iii) 2,000 enrollees for obstetrical/gynecological care;

(iv) 2,000 enrollees for behavioral health care or service; and

(v) 2,000 enrollees for substance use disorder care and services.

B. The network adequacy access plan executive summary form filed by a carrier pursuant to §A of this regulation is not confidential information.