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