Section 405 IAC 14-6-8 - Direct accessAuthority: IC 12-15-1-10
Affected: IC 12-15-5; IC 12-15-12
Sec. 8.
(a) Under federal requirements at 42 CFR 438.206(b)(2), an MCO serving the PathWays program must provide female PathWays members with direct access to a women's health specialist within the MCO's network for covered care necessary to provide routine and preventive health care services to women. This access is in addition to a female member's designated primary care source if that source is not a health specialist.(b) Under federal requirements at 42 CFR 438.208(c), an MCO serving the PathWays program must allow PathWays a member with special needs, determined to need a course of treatment or regular care monitoring, to directly access a specialist for treatment appropriate for the member's condition and identified needs.(c) An MCO shall have an established mechanism to ensure access services prescribed under subsections (a) and (b).Office of the Secretary of Family and Social Services; 405 IAC 14-6-8; filed 8/30/2024, 11:42 a.m.: 20240925-IR-405240180FRA