Regulations of Connecticut State Agencies
(a) The ASO shall develop and maintain a comprehensive network of providers that has the capacity to deliver, or arrange for the delivery of, all of the goods and services reimbursable under the SAGA program that are listed in section 17b-192-6(c) of the Regulations of Connecticut State Agencies.
(b) The ASO shall provide pharmaceutical services through pharmacies under contract with the ASO.
(c) The ASO shall ensure that its provider network:
(1) includes access for each member to a PCP, as well as obstetric and gynecological providers, at a distance of no more than twenty miles from the town where the member resides to the town where the provider is located as measured by the Department of Public Utility Control; and
(2) provides access to obstetricians and gynecologists in accordance with section 38a-503b of the Connecticut General Statutes.
(d) The ASO shall assign a PCP to each member. Such assignment shall be appropriate to the member's age, gender, and place of residence.
(e) The ASO shall implement procedures to permit members to select a PCP other than the PCP assigned by the ASO.
(f) Each member shall be offered the opportunity to choose among available providers in the provider network.
(g) A member may select any family planning provider or abortion provider for such services without regard to the provider's contractual relationship with the ASO.
(h) A member may use any emergency service without regard to the provider's contractual relationship with the ASO.
(i) The department shall require the ASO to have a system of referring members to out-of-network providers if appropriate participating providers are not available in the network.
(Adopted effective October 12, 2005)