Network Adequacy

Geographic Access Standards and Reports

The Department of Community Health currently contracts with the following three Care Management Organizations (CMOs) to deliver services to Medicaid members: Amerigroup, CareSource, and Peach State Health Plan. All 3 CMOs serve members residing in communities throughout the state of Georgia.

Doctor or nurse wearing stethoscope and gloves writing on clipboard.

Each CMO is required to develop and maintain a network of Providers and Facilities adequate to deliver Covered Services while ensuring adequate and appropriate provision of services to members under the Georgia Families Contract. To demonstrate that the requirement has been met, CMOs must conduct a geographic access analysis of their network utilizing the standards as outlined in Figure 1 of the Georgia Families Contract below:

Figure 1. Geographic Access Standards by Provider Type
Provider Type	Urban	Rural
PCPs*	Two (2) within eight (8) miles	Two (2) within fifteen (15) miles
Pediatricians	Two (2) within eight (8) miles	Two (2) within fifteen (15) miles
Obstetric Providers	Two (2) within thirty (30) minutes or thirty (30) miles	Two (2) within forty-five (45) minutes or forty-five (45) miles
Specialists	One (1) within thirty (30) minutes or thirty (30) miles	One (1) within forty-five (45) minutes or forty-five (45) miles
General Dental Providers	One (1) within thirty (30) minutes or thirty (30) miles	One (1) within forty-five (45) minutes or forty-five (45) miles
Dental Subspecialty Providers	One (1) within thirty (30) minutes or thirty (30) miles	One (1) within forty-five (45) minutes or forty-five (45) miles
Hospitals	One (1) within thirty (30) minutes or thirty (30) miles	One (1) within forty-five (45) minutes or forty-five (45) miles
Mental Health Providers	One (1) within thirty (30) minutes or thirty (30) miles	One (1) within forty-five (45) minutes or forty-five (45) miles
Pharmacies	One (1) twenty-four (24) hours a day, seven (7) days a week within fifteen (15) minutes or fifteen (15) miles	One (1) twenty-four (24) hours a day (or has an afterhours emergency phone number and pharmacist on call), seven (7) days a week within thirty (30) minutes or thirty (30) miles
Therapy: Physical Therapists, Occupational Therapists and Speech Therapists	One (1) within thirty (30) minutes or thirty (30) miles	One (1) within forty-five (45) minutes or forty-five (45) miles
Vision Providers	One (1) within thirty (30) minutes or thirty (30) miles	One (1) within forty-five (45) minutes or forty-five (45) miles

*PCPs not including practitioners listed below in Table.

The CMOs submit Network Adequacy Reports which provide member access data by county on a quarterly basis. Georgia requires that at least 90% of the members in each county have access to a provider when the contractual access standards are applied. In counties where access is below 90%, CMOs are required to provide a corrective action plan to address the deficiency. Corrective actions include recruiting additional providers where providers are available, contracting with providers in nearby counties to fills the gaps in access, or coordinating non-emergency transportation services, as necessary, to ensure that members receive care.

The network adequacy results presented for each CMO are based on network data submitted as of June 30, 2022. The reports are broken down by managed care region. Georgia has six (6) managed care regions: Atlanta, Central, East, North, Southeast, and Southwest. The counties contained within each region are classified as urban or rural as shown in the Georgia county map below.

Network Adequacy Reports

Network Adequacy Reports from prior years can be accessed here.

Amerigroup

CareSource

Georgia Families 360

Peach State Health Plan

Georgia County Map

Network Accessibility Standards

Network accessibility standards establish the maximum amount of time a member should have to wait to obtain an appointment with a participating provider based on the type and urgency of the service requested.

The CMOs must have in its network the capacity to ensure that waiting times for appointments do not exceed those outlined in Figure 2 of the Georgia Families Contract below.

Figure 2. Waiting Times by Provider Type
Provider Type	Waiting Time
PCPs (routine visits)	Not to exceed fourteen (14) calendar days
PCP (adult sick visit)	Not to exceed twenty-four (24) clock hours
PCP (pediatric sick visit)	Not to exceed twenty-four (24) clock hours
Maternity Care	First Trimester – Not to exceed fourteen (14) calendar days Second Trimester – Not to exceed seven (7) calendar days Third Trimester – Not to exceed three (3) business days
Specialists	Not to exceed thirty (30) calendar days
Therapy: Physical Therapists, Occupational Therapists, Speech Therapists, Aquatic Therapists	Not to exceed thirty (30) calendar days
Vision Providers	Not to exceed thirty (30) calendar days
Dental Providers (routine visits)	Not to exceed twenty-one (21) calendar days
Dental Providers (Urgent Care)	Not to exceed forty-eight (48) clock hours
Elective Hospitalizations	Thirty (30) calendar days
Mental Health Providers	Fourteen (14) calendar days
Urgent Care Providers	Not to exceed twenty-four (24) clock hours
Emergency Providers	Immediately (twenty-four (24) clock hours a day, seven (7) days a week) and without prior authorization