This CMS standard provides:

The MAO provides or arranges for necessary specialty care.

URAC implements these standard with a pair of standards, MAP-NM 12 and MAP-NM 13.

The Basics

These standard require that your organization:

• Give women direct access to women's health specialists (e.g., OB/GYNs) without going through another PCP; and
• Provide for access to out-of-network specialists when the provide network proves to have inadequate specialty care for the consumer.

You'll find you organization's particular approach to these issues in P&Ps, evidence of coverage, member handbook, and/or provider manual.

Management Tips

This relatively straightforward pair of standards should be clearly and explicitly addressed in your P&Ps and consumer documentations describing benefits, such as the EOC or member handbook.  You'll also need to make sure training on these standards goes well beyond the bounds of your network management staff, to include such staff members as customer service representatives who will have to handle calls from consumers seeking specialty care.

URAC Accreditation Tips

The documents for submission for desktop review are what you'd expect: provider contracts, P&Ps, member handbooks, and EOCs.  

The onsite interview will be directed at both CSRs and provider relations staff, and will cover such areas as women's access to OB/GYNs, examples of referral to non-participating providers, and specialty network adequacy.  The document review will involve you pulling files at the reviewer's request to show examples of how you handled out-of-network referrals where specialty care was inadequate within the network.