I was wondering if some can help me out with this assignment

I was wondering if some can help me out with this assignment, as I don\'t understand.

For this assignment, put yourself in the shoes of a state regulator. Based on the network adequacy requirements below and the insurer network for each scenario, would you approve the network? If not, why? (10 points for each scenario.) (This is obviously a simplified network adequacy analysis, a true analysis would be far more complex.) For your answer, please input text responses into WebCourses numbered 1-4 for each scenario. Remember to read all of the details of the network adequacy requirements and carefully review the time and distance for each provider.

Network Adequacy Requirements:

PCP 30 minutes/15 miles; at least 2 providers for every 500 members

Mental Health 30 minutes/15 miles; at least 1 provider for every 500 members

Specialty (Urology) 30 minutes/15 miles; at least 1 provider for every 1,500 members

Hospital: 30 minutes/15 miles; at least 1 for every 1,000 members (up to 2,000 members--in other words, no insurer needs to have more than 2 hospitals because there are only 2 hospitals in the geographic area)

EXAMPLE: Insurer: We Care Health Plan: Expected Enrollment 2,000 members

Provider Name

PCP/Specialty

Time/Distance

Dr. Cavenaugh

PCP-1 provider

30 min/15 miles

Dr. Jones

PCP-4 providers

60 min/30 miles

Radford Pediatrics

PCP-6 providers

60 min/30 miles

Dr. Singh

Mental Health-1 provider

30 min/15 miles

Behavioral Health Associates

Mental Health-3 providers

60 min/30 miles

St. James Hospital

Hospital

30 min/15 miles

Dr. Copeland

Urology-1 provider

30 min/15 miles

Based on a projected enrollment of 2,000 members, the insurer needs: 8 PCPs within 30 minutes/15 miles; 4 mental health providers within 30 minutes/15 miles; 2 urologists within 30 minutes/15 miles; and 2 hospitals within 30 minutes/15 miles.

Answer: The insurer fails to meet network adequacy standards because the network is missing 7 PCPs (within 30 minutes/15 miles), 3 mental health providers (within 30 minutes/15 miles); 1 urologist and a hospital.

ASSIGNMENT SCENARIOS:

Insurer: Wellness Experts Health Plan: Expected Enrollment 1,000 members

Provider Name

PCP/Specialty

Time/Distance

Dr. Smith

PCP-1 provider

30 min/15 miles

Primary Care Associates

PCP-6 providers

30 min/15 miles

Dr. Jones

PCP-4 providers

60 min/30 miles

Radford Pediatrics

PCP-4 providers

60 min/30 miles

Dr. Chamberlin

Mental Health-2 providers

30 min/15 miles

Dr. Singh

Mental Health-2 providers

30 min/15 miles

Behavioral Health Associates

Mental Health-3 providers

60 min/30 miles

Dr. Peterson

Mental Health-1 provider

30 min/15 miles

St. James Hospital

Hospital

30 min/15 miles

Dr. Copeland

Urology-2 providers

30 min/15 miles

Insurer: Healthy Start Health Plan: Expected Enrollment 1,000 members

Provider Name

PCP/Specialty

Time/Distance

Dr. Patel

PCP-1 provider

30 min/15 miles

Primary Care Associates

PCP-6 providers

30 min/15 miles

Dr. Chamberlin

Mental Health-1 provider

30 min/15 miles

Dr. Yiu

Mental Health-1 provider

30 min/15 miles

Behavioral Health Associates

Mental Health-3 providers

60 min/30 miles

Cambridge Hospital

Hospital

30 min/15 miles

Dr. Matheson

Urology-1 provider

30 min/15 miles

Urologist Associates

Urology-2 providers

60 min/30 miles

Insurer: Healthy Start Health Plan: Expected Enrollment 2,000 members

Provider Name

PCP/Specialty

Time/Distance

Dr. Hamilton

PCP-1 provider

30 min/15 miles

Anderson Pediatrics

PCP-3 providers

30 min/15 miles

Dr. Reid

PCP-2 providers

30 min/15 miles

Dr. Rogers

Mental Health-1 provider

30 min/15 miles

Behavioral Health Associates

Mental Health-3 providers

60 min/30 miles

St. James Hospital

Hospital

30 min/15 miles

Central Valley Hospital

Hospital

30 min/15 miles

Urologist Associates

Urology-2 providers

60 min/30 miles

Insurer: Healthy Start Health Plan: Expected Enrollment 3,000 members

Provider Name

PCP/Specialty

Time/Distance

Dr. Smith

PCP-1 provider

30 min/15 miles

Children’s Health Group

PCP-3 providers

30 min/15 miles

Dr. Jones

PCP-1 provider

30 min/15 miles

Primary Care Associates

PCP-6 providers

30 min/15 miles

Dr. Chamberlin

Mental Health-1 provider

30 min/15 miles

Dr. Singh

Mental Health-2 providers

30 min/15 miles

Behavioral Health Associates

Mental Health-3 providers

60 min/30 miles

Dr. Peterson

Mental Health-1 provider

30 min/15 miles

St. James Hospital

Hospital

30 min/15 miles

Central Valley Hospital

Hospital

30 min/15 miles

Urologist Associates

Urology-2 providers

60 min/30 miles

Provider Name	PCP/Specialty	Time/Distance
Dr. Cavenaugh	PCP-1 provider	30 min/15 miles
Dr. Jones	PCP-4 providers	60 min/30 miles
Radford Pediatrics	PCP-6 providers	60 min/30 miles
Dr. Singh	Mental Health-1 provider	30 min/15 miles
Behavioral Health Associates	Mental Health-3 providers	60 min/30 miles
St. James Hospital	Hospital	30 min/15 miles
Dr. Copeland	Urology-1 provider	30 min/15 miles

Solution

Scenario 1. Insurer: Wellness Experts Health Plan: Expected Enrollment 1,000 members

Based on a projected enrollment of 1,000 members, the insurer needs: 4 PCPs within 30 minutes/15 miles; 2 mental health providers within 30 minutes/15 miles; 1 urologists within 30 minutes/15 miles; and 1 hospital within 30 minutes/15 miles.

Answer: The insurer meets network adequacy standards because the network has 6 PCPs (more than required) from Primary Care Associates (within 30 minutes/15 miles), 2 mental health providers from Dr. Chamberin or Dr. Singh (within 30 minutes/15 miles); 2 urologists from Dr. Copeland (more than required) and a hospital named St. James Hospital.

Scenario 2. Insurer: Healthy Start Health Plan: Expected Enrollment 1,000 members

Based on a projected enrollment of 1,000 members, the insurer needs: 4 PCPs within 30 minutes/15 miles; 2 mental health providers within 30 minutes/15 miles; 1 urologists within 30 minutes/15 miles; and 1 hospital within 30 minutes/15 miles.

Answer: The insurer meets network adequacy standards because the network has 6 PCPs (more than required) from Primary Care Associates (within 30 minutes/15 miles), 2 mental health providers from Dr. Chamberin and Dr. Yiu (within 30 minutes/15 miles); 1 urologist from Dr. Matheson and a hospital named Cambridge.

Scenario 3. Insurer: Healthy Start Health Plan: Expected Enrollment 2,000 members

Based on a projected enrollment of 2,000 members, the insurer needs: 8 PCPs within 30 minutes/15 miles; 4 mental health providers within 30 minutes/15 miles; 2 urologists within 30 minutes/15 miles; and 2 hospitals within 30 minutes/15 miles.

Answer: The insurer fails to meet network adequacy standards because the network is missing 2 PCPs (within 30 minutes/15 miles), 3 mental health providers (within 30 minutes/15 miles) and 2 urologists.

Scenario 4. Insurer: Healthy Start Health Plan: Expected Enrollment 3,000 members

Based on a projected enrollment of 3,000 members, the insurer needs: 12 PCPs within 30 minutes/15 miles; 6 mental health providers within 30 minutes/15 miles; 2 urologists within 30 minutes/15 miles; and 2 hospitals within 30 minutes/15 miles.

Answer: The insurer fails to meet network adequacy standards because the network is missing 1 PCP (within 30 minutes/15 miles), 2 mental health providers (within 30 minutes/15 miles) and 2 urologists.