42 C.F.R. § 457.1230

Current through November 30, 2024
Section 457.1230 - Access standards
(a)Availability of services. The State must ensure that the services are available and accessible to enrollees in accordance with the terms of §438.206 of this chapter.
(b)Assurances of adequate capacity and services. The State must ensure, through its contracts, that each MCO, PIHP and PAHP has adequate capacity to serve the expected enrollment in accordance with the terms of § 438.207 of this chapter, except that the reporting requirements in § 438.207(d)(3)(i) of this chapter do not apply. The State must evaluate the most recent annual enrollee experience survey results as required at section 2108(e)(4) of the Act as part of the State's analysis of network adequacy as described at § 438.207(d) of this chapter.
(c)Coordination and continuity of care. The State must ensure, through its contracts, that each MCO, PIHP and PAHP complies with the coordination and continuity of care requirements in accordance with the terms of §438.208 of this chapter, except that the applicability date in §438.208(d) does not apply.
(d)Coverage and authorization of services. The State must ensure, through its contracts, that each MCO, PIHP, or PAHP complies with the coverage and authorization of services requirements in accordance with the terms of § 438.210 of this chapter, except that the following do not apply:
(1) Section 438.210(a)(5) of this chapter (related to medical necessity standard).
(2) Section 438.210(b)(2)(iii) of this chapter (related to authorizing long term services and supports (LTSS)).

42 C.F.R. §457.1230

81 FR 27897 , May 6, 2016, as amended at 82 FR 40 , Jan. 3, 2017; 89 FR 8985 , Feb. 8, 2024
81 FR 27852 , 5/6/2016; as amended at 82 FR 40 , 1/3/2017; 89 FR 8985 , 4/8/2024; 89 FR 41285 , 7/9/2024