Sec. 1301.00553. MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS BY PREFERRED PROVIDER TYPE.
(a)In this section, "maximum distance" means the miles calculated to drive by automobile within a service area to a particular type of preferred provider.
(b)For purposes of this section, each county in this state is classified as a large metro, metro, micro, or rural county, or a county with extreme access considerations as determined by the federal Centers for Medicare and Medicaid Services by population and density thresholds as of March 1, 2023.
(c)Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each large metro county are:
(1)for the following physicians, as designated by physician specialty:
| Time | Distance
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Sec. 1301.00553. MAXIMUM TRAVEL TIME AND DISTANCE STANDARDS BY PREFERRED PROVIDER TYPE. (a) In this section, "maximum distance" means the miles calculated to drive by automobile within a service area to a particular type of preferred provider.
(b) For purposes of this section, each county in this state is classified as a large metro, metro, micro, or rural county, or a county with extreme access considerations as determined by the federal Centers for Medicare and Medicaid Services by population and density thresholds as of March 1, 2023.
(c) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each large metro county are:
(1) for the following physicians, as designated by physician specialty:
| Time | Distance
Allergy and Immunology | 30 | 15
Cardiology | 20 | 10
Cardiothoracic Surgery | 30 | 15
Dermatology | 20 | 10
Emergency Medicine | 20 | 10
Endocrinology | 30 | 15
Ear, Nose, and Throat/Otolaryngology | 30 | 15
Gastroenterology | 20 | 10
General Surgery | 20 | 10
Gynecology and Obstetrics | 10 | 5
Infectious Diseases | 30 | 15
Nephrology | 30 | 15
Neurology | 20 | 10
Neurosurgery | 30 | 15
Oncology: Medical, Surgical | 20 | 10
Oncology: Radiation | 30 | 15
Ophthalmology | 20 | 10
Orthopedic Surgery | 20 | 10
Physical Medicine and Rehabilitation | 30 | 15
Plastic Surgery | 30 | 15
Primary Care: Adults | 10 | 5
Primary Care: Pediatric | 10 | 5
Psychiatry | 20 | 10
Pulmonology | 20 | 10
Rheumatology | 30 | 15
Urology | 20 | 10
Vascular Surgery | 30 | 15
(2) for health care practitioners in the following disciplines:
| Time | Distance
Chiropractic | 30 | 15
Occupational Therapy | 20 | 10
Physical Therapy | 20 | 10
Podiatry | 20 | 10
Speech Therapy | 20 | 10
(3) for the following types of institutional providers:
| Time | Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7) | 20 | 10
Cardiac Catheterization Services | 30 | 15
Cardiac Surgery Program | 30 | 15
Critical Care Services: Intensive Care Units | 20 | 10
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) | 20 | 10
Inpatient or Residential Behavioral Health Facility Services | 30 | 15
Mammography | 20 | 10
Outpatient Infusion/Chemotherapy | 20 | 10
Skilled Nursing Facilities | 20 | 10
Surgical Services (Outpatient or Ambulatory Surgical Center) | 20 | 10
(4) for the following settings:
| Time | Distance
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) | 10 | 5
Urgent Care | 20 | 10
(d) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each metro county are:
(1) for the following physicians, as designated by physician specialty:
| Time | Distance
Allergy and Immunology | 45 | 30
Cardiology | 30 | 20
Cardiothoracic Surgery | 60 | 40
Dermatology | 45 | 30
Emergency Medicine | 45 | 30
Endocrinology | 60 | 40
Ear, Nose, and Throat/Otolaryngology | 45 | 30
Gastroenterology | 45 | 30
General Surgery | 30 | 20
Gynecology and Obstetrics | 15 | 10
Infectious Diseases | 60 | 40
Nephrology | 45 | 30
Neurology | 45 | 30
Neurosurgery | 60 | 40
Oncology: Medical, Surgical | 45 | 30
Oncology: Radiation | 60 | 40
Ophthalmology | 30 | 20
Orthopedic Surgery | 30 | 20
Physical Medicine and Rehabilitation | 45 | 30
Plastic Surgery | 60 | 40
Primary Care: Adults | 15 | 10
Primary Care: Pediatric | 15 | 10
Psychiatry | 45 | 30
Pulmonology | 45 | 30
Rheumatology | 60 | 40
Urology | 45 | 30
Vascular Surgery | 60 | 40
(2) for health care practitioners in the following disciplines:
| Time | Distance
Chiropractic | 45 | 30
Occupational Therapy | 45 | 30
Physical Therapy | 45 | 30
Podiatry | 45 | 30
Speech Therapy | 45 | 30
(3) for the following types of institutional providers:
| Time | Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7) | 45 | 30
Cardiac Catheterization Services | 60 | 40
Cardiac Surgery Program | 60 | 40
Critical Care Services: Intensive Care Units | 45 | 30
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) | 45 | 30
Inpatient or Residential Behavioral Health Facility Services | 70 | 45
Mammography | 45 | 30
Outpatient Infusion/Chemotherapy | 45 | 30
Skilled Nursing Facilities | 45 | 30
Surgical Services (Outpatient or Ambulatory Surgical Center) | 45 | 30
(4) for the following settings:
| Time | Distance
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) | 15 | 10
Urgent Care | 45 | 30
(e) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each micro county are:
(1) for the following physicians, as designated by physician specialty:
| Time | Distance
Allergy and Immunology | 80 | 60
Cardiology | 50 | 35
Cardiothoracic Surgery | 100 | 75
Dermatology | 60 | 45
Emergency Medicine | 80 | 60
Endocrinology | 100 | 75
Ear, Nose, and Throat/Otolaryngology | 80 | 60
Gastroenterology | 60 | 45
General Surgery | 50 | 35
Gynecology and Obstetrics | 30 | 20
Infectious Diseases | 100 | 75
Nephrology | 80 | 60
Neurology | 60 | 45
Neurosurgery | 100 | 75
Oncology: Medical, Surgical | 60 | 45
Oncology: Radiation | 100 | 75
Ophthalmology | 50 | 35
Orthopedic Surgery | 50 | 35
Physical Medicine and Rehabilitation | 80 | 60
Plastic Surgery | 100 | 75
Primary Care: Adults | 30 | 20
Primary Care: Pediatric | 30 | 20
Psychiatry | 60 | 45
Pulmonology | 60 | 45
Rheumatology | 100 | 75
Urology | 60 | 45
Vascular Surgery | 100 | 75
(2) for health care practitioners in the following disciplines:
| Time | Distance
Chiropractic | 80 | 60
Occupational Therapy | 80 | 60
Physical Therapy | 80 | 60
Podiatry | 60 | 45
Speech Therapy | 80 | 60
(3) for the following types of institutional providers:
| Time | Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7) | 80 | 60
Cardiac Catheterization Services | 160 | 120
Cardiac Surgery Program | 160 | 120
Critical Care Services: Intensive Care Units | 160 | 120
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) | 80 | 60
Inpatient or Residential Behavioral Health Facility Services | 100 | 75
Mammography | 80 | 60
Outpatient Infusion/Chemotherapy | 80 | 60
Skilled Nursing Facilities | 80 | 60
Surgical Services (Outpatient or Ambulatory Surgical Center) | 80 | 60
(4) for the following settings:
| Time | Distance
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) | 30 | 20
Urgent Care | 80 | 60
(f) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each rural county are:
(1) for the following physicians, as designated by physician specialty:
| Time | Distance
Allergy and Immunology | 90 | 75
Cardiology | 75 | 60
Cardiothoracic Surgery | 110 | 90
Dermatology | 75 | 60
Emergency Medicine | 75 | 60
Endocrinology | 110 | 90
Ear, Nose, and Throat/Otolaryngology | 90 | 75
Gastroenterology | 75 | 60
General Surgery | 75 | 60
Gynecology and Obstetrics | 40 | 30
Infectious Diseases | 110 | 90
Nephrology | 90 | 75
Neurology | 75 | 60
Neurosurgery | 110 | 90
Oncology: Medical, Surgical | 75 | 60
Oncology: Radiation | 110 | 90
Ophthalmology | 75 | 60
Orthopedic Surgery | 75 | 60
Physical Medicine and Rehabilitation | 90 | 75
Plastic Surgery | 110 | 90
Primary Care: Adults | 40 | 30
Primary Care: Pediatric | 40 | 30
Psychiatry | 75 | 60
Pulmonology | 75 | 60
Rheumatology | 110 | 90
Urology | 75 | 60
Vascular Surgery | 110 | 90
(2) for health care practitioners in the following disciplines:
| Time | Distance
Chiropractic | 90 | 75
Occupational Therapy | 75 | 60
Physical Therapy | 75 | 60
Podiatry | 75 | 60
Speech Therapy | 75 | 60
(3) for the following types of institutional providers:
| Time | Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7) | 75 | 60
Cardiac Catheterization Services | 145 | 120
Cardiac Surgery Program | 145 | 120
Critical Care Services: Intensive Care Units | 145 | 120
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) | 75 | 60
Inpatient or Residential Behavioral Health Facility Services | 90 | 75
Mammography | 75 | 60
Outpatient Infusion/Chemotherapy | 75 | 60
Skilled Nursing Facilities | 75 | 60
Surgical Services (Outpatient or Ambulatory Surgical Center) | 75 | 60
(4) for the following settings:
| Time | Distance
Outpatient Clinical Behavioral | |
Health (Licensed, Accredited, or Certified) | 40 | 30
Urgent Care | 75 | 60
(g) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each county with extreme access considerations are:
(1) for the following physicians, as designated by physician specialty:
| Time | Distance
Allergy and Immunology | 125 | 110
Cardiology | 95 | 85
Cardiothoracic Surgery | 145 | 130
Dermatology | 110 | 100
Emergency Medicine | 110 | 100
Endocrinology | 145 | 130
Ear, Nose, and Throat/Otolaryngology | 125 | 110
Gastroenterology | 110 | 100
General Surgery | 95 | 85
Gynecology and Obstetrics | 70 | 60
Infectious Diseases | 145 | 130
Nephrology | 125 | 110
Neurology | 110 | 100
Neurosurgery | 145 | 130
Oncology: Medical, Surgical | 110 | 100
Oncology: Radiation | 145 | 130
Ophthalmology | 95 | 85
Orthopedic Surgery | 95 | 85
Physical Medicine and Rehabilitation | 125 | 110
Plastic Surgery | 145 | 130
Primary Care: Adults | 70 | 60
Primary Care: Pediatric | 70 | 60
Psychiatry | 110 | 100
Pulmonology | 110 | 100
Rheumatology | 145 | 130
Urology | 110 | 100
Vascular Surgery | 145 | 130
(2) for health care practitioners in the following disciplines:
| Time | Distance
Chiropractic | 125 | 110
Occupational Therapy | 110 | 100
Physical Therapy | 110 | 100
Podiatry | 110 | 100
Speech Therapy | 110 | 100
(3) for the following institutional providers:
| Time | Distance
Acute Inpatient Hospitals (Emergency Services Available 24/7) | 110 | 100
Cardiac Catheterization Services | 155 | 140
Cardiac Surgery Program | 155 | 140
Critical Care Services: Intensive Care Units | 155 | 140
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) | 110 | 100
Inpatient or Residential Behavioral Health Facility Services | 155 | 140
Mammography | 110 | 100
Outpatient Infusion/Chemotherapy | 110 | 100
Skilled Nursing Facilities | 95 | 85
Surgical Services (Outpatient or Ambulatory Surgical Center) | 110 | 100
(4) for the following settings:
| Time | Distance
Outpatient Clinical Behavioral | |
Health (Licensed, Accredited, or Certified) | 70 | 60
Urgent Care | 110 | 100