Protocol 4: Validation of Network Adequacy

This protocol verifies that Medicaid Managed Care Organizations (MCOs) maintain a provider network that is sufficient in size, scope, and specialty to meet member needs. It ensures enrollees have timely access to essential services, including primary, specialty, and behavioral health care, across geographic areas.

Access to Care

Protocol 4 activities ensure Medicaid enrollees can access needed services within acceptable time and distance standards.

Provider Sufficiency

Protocol 4 activities verify that MCOs have an adequate number and mix of providers, including specialists and behavioral health professionals.

Geographic Coverage

Protocol 4 activities assess whether the provider network meets the needs of members across all service regions.

Curriculum

3 Chapters · 3 Lessons

1. (Included in full purchase)
  Activities 1 and 2
1. (Included in full purchase)
  Activities 3 and 4
1. (Included in full purchase)
  Activities 5 and 6

Protocol 4: Validation of Network Adequacy