Specialty care
(3) Specialty care. Provide or arrange for necessary specialty care, and in particular give women enrollees the option of direct access to a women's health specialist within the network for women's routine and preventive health care services provided as basic benefits (as defined in 422.2). (4) Service area expansion. If seeking a service area expansion for an MA plan, demonstrate that the number and type of providers available to plan enrollees are sufficient to meet projected needs of the population to be served. (5) Credentialed providers. Demonstrate to CMS that its providers in an MA plan are credentialed through the process set forth at 422.204(a). (6) Written standards. Establish written standards for the following: (i) Timeliness of access to care and member services that meet or exceed standards in this paragraph. The MA organization must continuously monitor access to care and member services and must take corrective action as necessary to ensure that appointment wait times in the provider network comply with these standards. The minimum standards for appointment wait times for primary care and behavioral health services are as follows for appointments: (A) Urgently needed services or emergencyimmediately; (B) Services that are not emergency or urgently needed, but the enrollee requires medical attentionwithin 7 business days; and (C) Routine and preventive carewithin 30 business days. (ii) Policies and procedures (coverage rules, practice guidelines, payment policies, and utilization management) that allow for individual medical necessity determinations. (iii) Provider consideration of beneficiary input into the provider's proposed treatment plan. (7) Hours of operation. Ensure that (i) The hours of operation of its MA plan providers are convenient to the population served under the plan and do not discriminate against Medicare enrollees; and (ii) Plan services are available 24 hours a day, 7 days a week, when medically necessary. (8) Cultural considerations. Ensure that services are provided in a culturally competent manner to all enrollees, including those with limited English proficiency or reading skills, and diverse cultural and ethnic backgrounds. (9) Ambulance services, emergency and urgently needed services, and post-stabilization care services coverage. Provide coverage for ambulance services, emergency and urgently needed services, and post-stabilization care services in accordance with 422.113. (10) Prevailing patterns of community health care delivery. MA plans that meet Medicare access and availability requirements through direct contracting network providers must do so consistent with the prevailing community pattern of health care delivery in the areas where the network is being offered. Factors making up community patterns of health care delivery that CMS will use as a benchmark in evaluating a proposed MA plan health care delivery network include, but are not limited to the following: (i) The number and geographical distribution of eligible health care providers available to potentially contract with an MAO to furnish plan covered services within the proposed service area of the MA plans. (ii) The prevailing market conditions in the service area of the MA plan. Specifically, the number and distribution of health care providers contracting with other health care plans (both commercial and Medicare) operating in the service area of the plan. (iii) Whether the service area is comprised of rural or urban areas or some combination of the two. (iv) Whether the MA plan's proposed provider network meet Medicare time and distance standards for member access to health care providers including specialties. (v) Other factors that CMS determines are relevant in setting a standard for an acceptable health care delivery network in a particular service area.