§ 122.624. Requirements for service area expansion.
(a) A CCO may apply for approval of an expansion of its service area by submitting a request for the expansion to the Department. The expansion request shall include the following:
(1) The proposed new service area, by county.
(2) A list of participating coordinated care providers in the proposed new service area who are capable of providing primary medical services and other required health services in a manner that meets the standards in § 122.609 (relating to requirements for a CCO’s health service delivery system).
(3) A description of how required services such as case management and communication, utilization review and quality assurance will be extended to serve injured workers in the proposed additional service area and a description of the CCO’s plans for increased staffing to expand these services.
(b) The Department will treat an application to expand a CCO’s service area as an application to amend the CCO’s certification.
(c) The filing fee for a service area expansion will be established by regulation. The Department anticipates that this fee will be approximately $500.
(d) A CCO may not provide coordinated care services in a new service area until the Department has specifically approved the service area expansion request.
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