Md. Code Regs. 10.67.05.06

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.67.05.06 - Geographical Access

A. Except as provided in §C of this regulation, an MCO shall develop and maintain a provider network that meets the following time and distance standards:

(1) For adult and pediatric primary care, pharmacy, diagnostic laboratory and x-ray, and gynecology:

(a) In urban areas, within 15 minutes or 10 miles;

(b) In suburban areas, within 30 minutes or 20 miles; and

(c) In rural areas, within 40 minutes or 30 miles;

(2) For prenatal care, as defined in §B of this regulation:

(a) In urban areas, within 15 minutes or 10 miles;

(b) In suburban areas, within 30 minutes or 20 miles; and

(c) In rural areas, within 90 minutes or 75 miles;

(3) For acute inpatient hospitals:

(a) In urban areas, within 20 minutes or 10 miles;

(b) In suburban areas, within 45 minutes or 30 miles; and

(c) In rural areas, within 75 minutes or 60 miles;

(4) For core specialty types, as defined in Regulation .05-1A(2)(b) of this chapter:

(a) In urban areas, within 30 minutes or 15 miles;

(b) In suburban areas, within 60 minutes or 45 miles; and

(c) In rural areas, within 90 minutes or 75 miles;

(5) For major specialty types, as defined in Regulation .05-1A(2)(c) of this chapter:

(a) In urban areas, within 30 minutes or 15 miles;

(b) In suburban areas, within 80 minutes or 60 miles; and

(c) In rural areas, within 110 minutes or 90 miles; and

(6) For pediatric subspecialty types, as defined in Regulation .05-1A(2)(d) of this chapter:

(a) In urban areas, within 30 minutes or 15 miles;

(b) In suburban areas, within 80 minutes or 60 miles; and

(c) In rural areas, within 250 minutes or 200 miles.

B. Prenatal Care Providers. For the purposes of provider network adequacy, prenatal care providers may include, but are not limited to:

(1) Obstetricians;

(2) Certified nurse midwives; and

(3) Family practitioners who provide prenatal care and perform deliveries.

C. If an MCO can otherwise demonstrate to the Department's satisfaction the adequacy of its provider network notwithstanding its inability to meet the requirements of §A of this regulation, the Department may, in its discretion, approve the network if special circumstances exist which, considered along with the overall strength of the MCO's network, establish that the Department's approval of the network will enhance recipients' overall access to quality health care services in the area to be served.

D. Geographical Access: Local Access Areas.

Local Access Area	Zip Codes
Allegany	21501, 21502, 21503, 21504, 21505, 21521, 21523, 21524, 21528, 21529, 21530, 21532, 21539, 21540, 21542, 21543, 21545, 21546, 21555, 21556, 21557, 21560, 21562, 21766
Anne Arundel North	20701, 20724, 20755, 21056, 21060, 21061, 21076, 21077, 21090, 21108, 21113, 21122, 21123, 21144, 21240
Anne Arundel South	20711, 20733, 20751, 20764, 20765, 20776, 20778, 20779, 21012, 21032, 21035, 21037, 21054, 21106, 21114, 21140, 21146, 21401, 21402, 21403, 21404, 21405, 21409
Baltimore City SE/Dundalk	21052, 21219, 21222, 21224, 21281
Baltimore City East	21202, 21203, 21205, 21213, 21231, 21287
Baltimore City North Central	21210, 21211, 21218
Baltimore City Northeast	21206, 21212, 21214, 21239
Baltimore City Northwest	21208, 21209, 21215, 21270
Baltimore City South	21225, 21226, 21230
Baltimore City West	21201, 21216, 21217, 21223
Baltimore County East	21021, 21022, 21027, 21051, 21087, 21128, 21156, 21162, 21220, 21221, 21236, 21237
Baltimore County North	21013, 21023, 21030, 21031, 21053, 21057, 21082, 21092, 21093, 21094, 21105, 21111, 21120, 21131, 21139, 21152, 21153, 21155, 21161, 21204, 21234, 21284, 21285, 21286
Baltimore County Northwest	21055, 21071, 21117, 21133, 21136, 21163, 21207, 21244, 21282
Baltimore County Southwest	21227, 21228, 21229
Calvert	20610, 20615, 20629, 20639, 20657, 20676, 20678, 20685, 20688, 20689, 20714, 20732, 20736, 20754, 20758
Caroline	21609, 21629, 21632, 21636, 21639, 21640, 21641, 21649, 21655, 21660, 21670
Carroll	21020, 21048, 21074, 21088, 21102, 21104, 21157, 21158, 21757, 21771, 21776, 21784, 21787, 21791
Cecil	21901, 21902, 21903, 21904, 21911, 21912, 21913, 21914, 21915, 21916, 21917, 21918, 21919, 21920, 21921, 21922, 21930
Charles	20601, 20602, 20603, 20604, 20611, 20612, 20616, 20617, 20622, 20625, 20632, 20637, 20640, 20643, 20645, 20646, 20658, 20661, 20662, 20664, 20675, 20677, 20682, 20693, 20695
Dorchester	21613, 21622, 21626, 21627, 21631, 21634, 21643, 21648, 21659, 21664, 21669, 21672, 21675, 21677, 21835, 21869
Frederick	21701, 21702, 21703, 21704, 21705, 21710, 21714, 21716, 21717, 21718, 21727, 21754, 21755, 21758, 21759, 21762, 21769, 21770, 21773, 21774, 21775, 21777, 21778, 21780, 21788, 21790, 21792, 21793, 21798
Garrett	21520, 21522, 21531, 21536, 21538, 21541, 21550, 21561
Harford East	21001, 21005, 21017, 21018, 21024, 21028, 21034, 21078, 21130
Harford West	21009, 21010, 21014, 21015, 21040, 21047, 21050, 21084, 21085, 21101, 21132, 21154, 21160
Howard County	20723, 20759, 20763, 20777, 20794, 21029, 21036, 21041, 21042, 21043, 21044, 21045, 21046, 21150, 21723, 21737, 21738, 21765, 21794, 21797
Kent	21610, 21620, 21635, 21637, 21645, 21646, 21650, 21661, 21667, 21678
Montgomery Mid-County	20812, 20813, 20814, 20815, 20816, 20817, 20818, 20824, 20825, 20827, 20830, 20832, 20833, 20848, 20849, 20850, 20851, 20852, 20853, 20854, 20855, 20857, 20859, 20889, 20891, 20892, 20895, 20896
Montgomery North	20837, 20838, 20839, 20841, 20842, 20847, 20871, 20872, 20874, 20875, 20876, 20877, 20878, 20879, 20880, 20882, 20883, 20884, 20885, 20886, 20898, 20997
Montgomery - Silver Spring	20860, 20861, 20862, 20866, 20868, 20901, 20902, 20903, 20904, 20905, 20906, 20907, 20908, 20910, 20911, 20912, 20913, 20914, 20915, 20916, 20918, 20990
Prince George's Northeast	20704, 20705, 20707, 20708, 20709, 20715, 20716, 20717, 20718, 20719, 20720, 20721, 20725, 20726, 20769
Prince George's Northwest	20703, 20706, 20710, 20712, 20722, 20731, 20737, 20738, 20740, 20741, 20742, 20743, 20768, 20770, 20771, 20780, 20781, 20782, 20783, 20784, 20785, 20787, 20788, 20789, 20791, 20792, 20797, 20799
Prince George's Southeast	20608, 20613, 20623, 20735, 20762, 20772, 20773, 20774, 20775
Prince George's Southwest	20607, 20744, 20745, 20746, 20747, 20748, 20749, 20750, 20752, 20753, 20757, 20790
Queen Anne's	21607, 21617, 21619, 21623, 21628, 21638, 21644, 21651, 21656, 21657, 21658, 21666, 21668
Somerset	21816, 21817, 21820, 21821, 21824, 21836, 21838, 21853, 21857, 21866, 21867, 21686, 21870, 21871, 21890
St. Mary's	20606, 20609, 20618, 20619, 20620, 20621, 20624, 20626, 20627, 20628, 20630, 20634, 20635, 20636, 20650, 20653, 20656, 20659, 20660, 20667, 20670, 20674, 20680, 20684, 20686, 20687, 20690, 20692
Talbot	21601, 21612, 21624, 21625, 21647, 21652, 21653, 21654, 21662, 21663, 21665, 21671, 21673, 21676, 21679
Washington	21711, 21713, 21715, 21719, 21720, 21721, 21722, 21733, 21734, 21740, 21741, 21742, 21746, 21750, 21756, 21767, 21779, 21781, 21782, 21783, 21795
Wicomico	21801, 20802, 21803, 21804, 21810, 21814, 21822, 21826, 21830, 21837, 21840, 21849, 21850, 21852, 21856, 21861, 21865, 21874, 21875
Worcester	21811, 21813, 21829, 21841, 21842, 21843, 21851, 21862, 21863, 21864, 21872

E. For purposes of this regulation:

(1) Urban enrollment area includes Baltimore City;

(2) Rural enrollment counties include:

(a) Allegany;

(b) Calvert;

(c) Caroline;

(d) Cecil;

(e) Charles;

(f) Dorchester;

(g) Frederick;

(h) Garrett;

(i) Kent;

(j) Queen Anne's

(k) Saint Mary's;

(l) Somerset;

(m) Talbot;

(n) Washington;

(o) Wicomico; and

(p) Worcester; and

(3) Suburban enrollment counties include:

(a) Baltimore County

(b) Anne Arundel;

(c) Carroll;

(d) Harford;

(e) Howard;

(f) Montgomery; and

(g) Prince George's.

Md. Code Regs. 10.67.05.06

Regulations .06 recodified from 10.09.66.06 effective 46:22 Md. R. 976, eff. 11/1/2019