Sec. 31.10.44.06. Provider-to-Enrollee Ratio Standards

A. Except for a Group Model HMO’s health benefit plan, the provider panel for each carrier shall meet the provider-to-enrollee ratio standards listed in §B of this regulation.

B. The provider-to-enrollee ratios shall be equivalent to at least 1 full-time physician, or as appropriate, another full-time provider for:

(1) 1,200 enrollees for primary care;

(2) 2,000 enrollees for pediatric care;

(3) 2,000 enrollees for obstetrical/gynecological care;

(4) 2,000 enrollees for behavioral health care or services; and

(5) 2,000 enrollees for substance use disorder care or services.