Statutes, codes, and regulations
Colorado Administrative Code
Department 700 - Department of Regulatory AgenciesDivision 702 - Division of InsuranceRule 3 CCR 702-4 - LIFE, ACCIDENT AND HEALTHSection 3 CCR 702-4 Series 4-2 - LIFE, ACCIDENT AND HEALTH, Series 4-2 Accident and Health (General)
Regulation Regulation 4-2-53 - NETWORK ADEQUACY STANDARDS AND REPORTING REQUIREMENTS FOR ACA-COMPLIANT HEALTH BENEFIT PLANS
Section 3 CCR 702-4-2-53-8 - Geographic Access Standards

3 Colo. Code Regs. § 702-4-2-53-8

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Current through Register Vol. 47, No. 8, April 25, 2024
Section 3 CCR 702-4-2-53-8 - Geographic Access Standards
A. The carrier shall attest that at least one (1) of each of the providers and facilities listed below is available within the maximum road travel distance of any enrollee in each specific carrier's network.
B. Access standards may require that a policyholder cross county or state lines to reach a provider.
C. Network Adequacy Geographic Access Standards by Provider Type:

Specialty

Geographic Type

Large Metro

Metro

Micro

Rural

CEAC

Maximum Distance

(miles)

Maximum Distance

(miles)

Maximum Distance

(miles)

Maximum Distance

(miles)

Maximum Distance

(miles)

Primary Care

5

10

20

30

60

Gynecology, OB/GYN

5

10

20

30

60

Pediatrics - Routine/Primary Care

5

10

20

30

60

Allergy and Immunology

15

30

60

75

110

Cardiothoracic Surgery

15

40

75

90

130

Cardiovascular Disease

10

20

35

60

85

Chiropracty

15

30

60

75

110

Dermatology

10

30

45

60

100

Endocrinology

15

40

75

90

130

ENT/Otolaryngology

15

30

60

75

110

Gastroenterology

10

30

45

60

100

General Surgery

10

20

35

60

85

Gynecology only

15

30

60

75

110

Infectious Diseases

15

40

75

90

130

Licensed Clinical Social Worker

10

30

45

60

100

Nephrology

15

30

60

75

110

Neurology

10

30

45

60

100

Neurological Surgery

15

40

75

90

130

Oncology - Medical, Surgical

10

30

45

60

100

Oncology - Radiation/ Radiation Oncology

15

40

75

90

130

Ophthalmology

10

20

35

60

85

Optometry for routine pediatric vision services

15

30

60

75

110

Orthopedic Surgery

10

20

35

60

85

Physiatry, Rehabilitative Medicine

15

30

60

75

110

Plastic Surgery

15

40

75

90

130

Podiatry

10

30

45

60

100

Psychiatry

10

30

45

60

100

Psychology

10

30

45

60

100

Pulmonology

10

30

45

60

100

Rheumatology

15

40

75

90

130

Urology

10

30

45

60

100

Vascular Surgery

15

40

75

90

130

OTHER MEDICAL PROVIDER

15

40

75

90

130

Dentist

15

30

60

75

110

Pharmacy

5

10

20

30

60

Acute Inpatient Hospitals

10

30

60

60

100

Cardiac Surgery Program

15

40

120

120

140

Cardiac Catheterization Services

15

40

120

120

140

Critical Care Services - Intensive Care Units (ICU)

10

30

120

120

140

Outpatient Dialysis

10

30

50

50

90

Surgical Services (Outpatient or ASC)

10

30

60

60

100

Skilled Nursing Facilities

10

30

60

60

85

Diagnostic Radiology

10

30

60

60

100

Mammography

10

30

60

60

100

Physical Therapy

10

30

60

60

100

Occupational Therapy

10

30

60

60

100

Speech Therapy

10

30

60

60

100

Inpatient Psychiatric Facility

15

45

75

75

140

Orthotics and Prosthetics

15

30

120

120

140

Outpatient Infusion/Chemotherapy

10

30

60

60

100

OTHER FACILITIES

15

40

120

120

140

3 CCR 702-4-2-53-8

37 CR 11, June 10, 2014, effective 7/1/2014
37 CR 12, June 25, 2014, effective 7/15/2014
Colorado Register, Vol 37, No. 14. July 25, 2014, effective 8/15/2014
37 CR 23, December 10, 2014, effective 1/1/2015
38 CR 03, February 10, 2015, effective 3/15/2015
38 CR 06, March 25, 2015, effective 4/30/2015
38 CR 09, May 10, 2015, effective 6/1/2015
38 CR 13, July 10, 2015, effective 7/30/2015
38 CR 19, October 10, 2015, effective 11/1/2015
38 CR 21, November 10, 2015, effective 1/1/2016
38 CR 23, December 10, 2015, effective 1/1/2016
39 CR 01, January 10, 2016, effective 2/1/2016
39 CR 05, March 10, 2016, effective 4/1/2016
39 CR 08, April 25, 2016, effective 5/15/2016
39 CR 19, October 10, 2016, effective 11/1/2016
39 CR 20, October 25, 2016, effective 1/1/2017
39 CR 22, November 25, 2016, effective 1/1/2017
39 CR 23, December 10, 2016, effective 1/1/2017
39 CR 23, December 25, 2016, effective 1/1/2017
40 CR 03, February 10, 2017, effective 3/15/2017
40 CR 09, May 10, 2017, effective 6/1/2017
40 CR 15, August 10, 2017, effective 9/1/2017
40 CR 17, September 10, 2017, effective 10/1/2017
40 CR 21, November 10, 2017, effective 12/1/2017
41 CR 04, February 25, 2018, effective 4/1/2018
41 CR 05, March 10, 2018, effective 6/1/2018
41 CR 08, April 25, 2018, effective 6/1/2018
41 CR 09, May 10, 2018, effective 6/1/2018
41 CR 11, June 10, 2018, effective 7/1/2018
41 CR 15, August 10, 2018, effective 9/1/2018
41 CR 17, September 10, 2018, effective 10/1/2018
41 CR 18, September 25, 2018, effective 10/15/2018
41 CR 21, November 10, 2018, effective 12/1/2018
41 CR 23, December 10, 2018, effective 1/1/2019
42 CR 01, January 10, 2019, effective 2/1/2019
41 CR 19, October 10, 2018, effective 3/1/2019
42 CR 03, February 10, 2019, effective 4/1/2019
42 CR 04, February 25, 2019, effective 4/1/2019
42 CR 06, March 25, 2019, effective 6/1/2019
42 CR 08, April 10, 2019, effective 6/1/2019
42 CR 15, August 10, 2019, effective 9/1/2019
42 CR 17, September 10, 2019, effective 10/1/2019
43 CR 02, January 25, 2020, effective 12/20/2019
43 CR 02, January 25, 2020, effective 12/23/2019
42 CR 23, December 10, 2019, effective 1/1/2020
43 CR 01, January 10, 2020, effective 2/1/2020
42 CR 24, December 25, 2019, effective 2/2/2020
43 CR 06, March 25, 2020, effective 4/15/2020
43 CR 10, May 25, 2020, effective 8/1/2020
43 CR 14, July 25, 2020, effective 8/15/2020
43 CR 17, September 10, 2020, effective 10/1/2020
43 CR 18, September 25, 2020, effective 11/1/2020
43 CR 22, November 25, 2020, effective 12/15/2020
43 CR 24, December 25, 2020, effective 1/15/2021
44 CR 03, February 10, 2021, effective 3/15/2021
44 CR 08, April 25, 2021, effective 5/15/2021
44 CR 09, May 10, 2021, effective 6/1/2021
44 CR 10, May 25, 2021, effective 6/14/2021
44 CR 10, May 25, 2021, effective 6/15/2021
44 CR 13, July 10, 2021, effective 8/1/2021
44 CR 15, August 10, 2021, effective 9/1/2021
44 CR 19, October 10, 2021, effective 11/1/2021
44 CR 21, November 10, 2021, effective 12/1/2021
44 CR 23, December 10, 2021, effective 12/30/2021
44 CR 21, November 10, 2021, effective 1/1/2022
44 CR 23, December 10, 2021, effective 1/15/2022
44 CR 24, December 25, 2021, effective 1/15/2022
45 CR 03, February 10, 2022, effective 3/2/2022
45 CR 08, April 25, 2022, effective 5/30/2022
45 CR 09, May 10, 2022, effective 5/30/2022
45 CR 10, May 25, 2022, effective 6/14/2022
45 CR 11, June 10, 2022, effective 6/30/2022
45 CR 11, June 10, 2022, effective 7/15/2022
45 CR 19, October 10, 2022, effective 11/1/2022
45 CR 20, October 25, 2022, effective 11/14/2022
45 CR 21, November 10, 2022, effective 11/30/2022
45 CR 24, December 25, 2022, effective 1/14/2023
46 CR 01, January 10, 2023, effective 2/14/2023
46 CR 06, March 25, 2023, effective 2/15/2023
46 CR 03, February 10, 2022, effective 3/2/2023
46 CR 04, February 25, 2023, effective 3/17/2023
46 CR 05, March 10, 2023, effective 4/15/2023
46 CR 09, May 10, 2023, effective 5/30/2023
46 CR 09, May 10, 2023, effective 6/1/2023
46 CR 10, May 25, 2023, effective 6/15/2023
46 CR 11, June 10, 2023, effective 6/30/2023