Explore State and Federal Statutes and Regulations

Authority and Purpose; Applicability and Scope; Definitions; Application for Selection as an IDRE; Conflict of Interest; Responsibilities of Carriers; Process to Submit and Resolve Disputes; Severability; Effective date

Definitions; Access Plan Filing and Review Guidelines; Access Plan Updates; Access Plan Specifications; Access Criteria; Mandatory Coverage; Provider-Enrollee Ratio Requirements; Verification of Provider Credentials; Geographic Access Criteria; Exceptions to Geographic Access Criteria; Service Areas; Referral and Specialty Care Requirements; Continuity of Care and Transitional Care; Selecting and Changing Providers; Removal of Barriers to Access; Monitoring the Network; Letters of Intent; Responsibility of Contracted Services