State Law

Arizona Admin. Code-Title 20-Chapter 6-Article 19. Health Care Services Organizations Oversight

06/15/2020 Arizona Section R20-6-1916

Availability Ratios

Network Adequacy

A. An HCSO shall maintain a ratio of contracted adult PCPs to adults that is adequate to provide those adults with covered services. An HCSO with a Medicare Advantage (MA) plan may have one ratio that applies to both its insured and MA populations, or a separate ratio for each.

B. An HCSO shall maintain a ratio of contracted pediatric PCPs to children that is adequate to provide those children enrollees with covered services.

C. An HCSO shall maintain a ratio of contracted high profile SCPs to enrollees that is adequate to provide those enrollees with covered services that include services at contracted facilities. An HCSO with a MA plan may have one ratio that applies to both its insured and MA populations, or a separate ratio for each.

SeeĀ https://apps.azsos.gov/public_services/Title_20/20-06.pdf