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Network Adequacy

In order to strengthen access to services in a managed care network, the Final Rule requires states to establish network adequacy standards in Medicaid managed care for key types of providers, while leaving states the flexibility to set the actual standards. The Final Rule requires that states:
  • Develop and implement time and distance standards for primary and specialty care (adult and pediatric), behavioral health (adult and pediatric), OB/GYN, pediatric dental, hospital, and pharmacy providers;
  • Develop and implement timely access standards for long-term services and supports (LTSS) providers who travel to the beneficiary to provide services; and
  • Assess and certify the adequacy of a managed care plan’s provider network at least annually.
 
The Final Rule network adequacy requirements are effective in the July 1, 2018 health plan contract year.
 
The Network Adequacy Standards proposal outlines the approach that DHCS has undertaken to develop the standards and describes monitoring activities for ongoing compliance. 
 

Managed Care Plans

 

Mental Health Plans 

Drug Medi-Cal Organized Delivery System (DMC-ODS) Pilots

Dental Managed Care Plans

 
Last modified date: 9/10/2019 3:15 PM