405 IAC 14-6-8 Direct access

Sec. 8. (a) Under federal requirements at 42 CFR 438.206(b)(2), an MCO serving the PathWays program must provide female PathWays members with direct access to a women's health specialist within the MCO's network for covered care necessary to provide routine and preventive health care services to women. This access is in addition to a female member's designated primary care source if that source is not a health specialist. (b) Under federal requirements at 42 CFR 438.208(c), an MCO serving the PathWays program must allow PathWays a member with special needs, determined to need a course of treatment or regular care monitoring, to directly access a specialist for treatment appropriate for the member's condition and identified needs. (c) An MCO shall have an established mechanism to ensure access services prescribed under subsections (a) and (b).