New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter 6 - PROVIDER NETWORK
Section 11:24-6.3 - Institutional services
Current through Register Vol. 56, No. 24, December 18, 2024
(a) The HMO shall maintain contracts or other arrangements acceptable to the Department with institutional providers which have the capability to meet the medical needs of members and are geographically accessible. The network of providers shall include:
(b) The HMO may request, and will be granted, relief from the time and mileage requirements in (a) above where it can document to the satisfaction of the Department that appropriate access to alternative sites is available. Such documentation shall address travel accommodations and travel times, financial hardship placed on families and other logistical details as requested by the Department of a specific HMO.
(c) In any county or approved sub-county service area in which 20 percent of an HMO's projected or actual membership must rely upon public transportation to access health care services, as documented by U.S. Census Data, the driving times in the criteria in (a) above shall be based upon average transit time using public transportation. The HMO shall demonstrate how it will meet this requirement in its application.