other plan requirements

Other Plan Requirements

NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT)

Beneficiary Protections

Network Adequacy Requirements

Standard Plan members must have access to care management to address medical and nonmedical drivers of health care

Team-based, person-centered approach to manage patients’ medical, social, and behavioral conditions

Local care management preferred (in site of care, home, or community that is face-to-face)

Plans must meet NCDHHS’ network adequacy standards: Maximum Distance to Care Maximum Waiting time for Care Standards for Primary care and Specialists

Out-of-network care must be covered if plan can't timely provide in-network care

Provider directory must be current

Provide NEMT appropriate for the member to the nearest enrolled medical provider

Develop a network of NEMT providers

Department approves all marketing materials and plans cannot engage in direct solicitations.

Plans must provide language assistance services, including interpretation and translation

Grievance, appeal and state fair hearing procedures,

Care Management

Provide travel-related expenses including: Lodging, food, parking fees/tolls, transportation vouchers

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