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
Section 114-100-3 - Network Adequacy Standards
Current through Register Vol. XLI, No. 38, September 20, 2024
3.1. The geographic accessibility standards set forth in Appendix A shall be met by a health carrier in order to comply with network adequacy requirements.
3.2. The following appointment wait times standards shall be met by a health carrier in order to comply with network adequacy requirements:
|
Provider/Facility Specialty Type |
Appointments Must Be Available Within |
|
Behavioral Health |
10 business days |
|
Primary Care (Routine) |
15 business days |
|
Specialty Care (Non-Urgent) |
30 business days |
3.3. If a carrier cannot meet the network adequacy standards set forth in section 3 of this rule, the carrier must have a process to assure that a covered person obtains a covered benefit at an in-network level of benefits from a nonparticipating provider or make other arrangements acceptable to the Commissioner, which may include contracting with the nearest like provider.
