West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-100 - Health Benefit Plan Network Access And Adequacy
Appendix A
|
Provider Specialty |
Geographic Accessibility Standards Maximum Time (in minutes) and Distance (in miles) Standards |
|||||||||
|
Large Metro |
Metro |
Micro |
Rural |
CEAC |
||||||
|
Time |
Distance |
Time |
Distance |
Time |
Distance |
Time |
Distance |
Time |
Distance |
|
|
Allergy and Immunology |
30 |
15 |
45 |
30 |
80 |
60 |
90 |
75 |
125 |
110 |
|
Cardiology |
20 |
10 |
30 |
20 |
50 |
35 |
75 |
60 |
95 |
85 |
|
Cardiothoracic Surgery |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
Chiropractor |
30 |
15 |
45 |
30 |
80 |
60 |
90 |
75 |
125 |
110 |
|
Dermatology |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
Dental |
30 |
15 |
45 |
30 |
80 |
60 |
90 |
75 |
125 |
110 |
|
Emergency Medicine |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Endocrinology |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
ENT/Otolaryngology |
30 |
15 |
45 |
30 |
80 |
60 |
90 |
75 |
125 |
110 |
|
Gastroenterology |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
General Surgery |
20 |
10 |
30 |
20 |
50 |
35 |
75 |
60 |
95 |
85 |
|
Gynecology, OB/GYN |
10 |
5 |
15 |
10 |
30 |
20 |
40 |
30 |
70 |
60 |
|
Infectious Diseases |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
Nephrology |
30 |
15 |
45 |
30 |
80 |
60 |
90 |
75 |
125 |
110 |
|
Neurology |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
Neurosurgery |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
Occupational Therapy |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Oncology - Medical, Surgical |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
Oncology - Radiation |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
Ophthalmology |
20 |
10 |
30 |
20 |
50 |
35 |
75 |
60 |
95 |
85 |
|
Orthopedic Surgery |
20 |
10 |
30 |
20 |
50 |
35 |
75 |
60 |
95 |
85 |
|
Outpatient Clinical Behavioral Health |
10 |
5 |
15 |
10 |
30 |
20 |
40 |
30 |
70 |
60 |
|
Physical Medicine and Rehabilitation |
30 |
15 |
45 |
30 |
80 |
60 |
90 |
75 |
125 |
110 |
|
Physical Therapy |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Plastic Surgery |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
Podiatry |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
Primary Care - Adult |
10 |
5 |
15 |
10 |
30 |
20 |
40 |
30 |
70 |
60 |
|
Primary Care - Pediatric |
10 |
5 |
15 |
10 |
30 |
20 |
40 |
30 |
70 |
60 |
|
Psychiatry |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
Pulmonology |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
Rheumatology |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
Speech Therapy |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Urology |
20 |
10 |
45 |
30 |
60 |
45 |
75 |
60 |
110 |
100 |
|
Vascular Surgery |
30 |
15 |
60 |
40 |
100 |
75 |
110 |
90 |
145 |
130 |
|
Acute Inpatient Hospitals (must have Emergency services available 24/7) |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Cardiac Catheterization Services |
30 |
15 |
60 |
40 |
160 |
120 |
145 |
120 |
155 |
140 |
|
Cardiac Surgery |
30 |
15 |
60 |
40 |
160 |
120 |
145 |
120 |
155 |
140 |
|
Critical Care Services (ICU) |
20 |
10 |
45 |
30 |
160 |
120 |
145 |
120 |
155 |
140 |
|
Diagnostic Radiology |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Inpatient or Residential Behavioral Health Facility Services |
30 |
15 |
70 |
45 |
100 |
75 |
90 |
75 |
155 |
140 |
|
Mammography |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Outpatient Infusion/Chemotherapy |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Skilled Nursing |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
95 |
85 |
|
Surgical Services |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
|
Urgent Care |
20 |
10 |
45 |
30 |
80 |
60 |
75 |
60 |
110 |
100 |
