6.6.8806    ACCESS PLAN UPDATES

(1) Health carriers shall be responsible for monitoring the status of their networks and must submit an updated access plan to the commissioner within 30 calendar days after a material change in the status of their network. For the purposes of this rule, a material change is a change in the composition of a health carrier's provider network or a change in the size or demographic characteristics of the population enrolled with the health carrier that renders the health carrier's network non-compliant with one or more of the network adequacy standards set forth in ARM 6.6.8815, 6.6.8819, and 6.6.8827. If the revised access plan is not submitted within 30 calendar days after the material change in network status occurs, the health carrier must cease enrolling new recipients in the affected geographic service area until the revised access plan is approved by the commissioner. Review of the revised access plan is subject to the procedures and consequences outlined in ARM 6.6.8805.

(2) In addition to the requirement in (1):

(a) the health carrier must submit an updated access plan to the commissioner pursuant to 33-36-201(4), MCA; and

(b)  health carriers must file an updated access plan with the commissioner if the number of providers in the overall provider network or in any specialty provider network decreases by more than 5% during the year in any single geographic service area or in the overall network.  The carrier must file the plan within 30 days of the date the carrier learns of the decrease.

 

History: 33-36-105, MCA; IMP, 33-36-105, 33-36-201, MCA; NEW, 1999 MAR p. 2052, Eff. 9/24/99; TRANS, from 37.108.206, 2023 MAR p. 1401, Eff. 10/21/23; AMD, 2024 MAR p. 713, Eff. 4/13/24.