A contract to which this subchapter applies must require the contracting Medicaid managed care organization to demonstrate to the commission, before the organization begins providing health care services to recipients, that, subject to the provider access standards the commission establishes under § 540.0652:
(1) the organization’s provider network has the capacity to serve the number of recipients expected to enroll in a Medicaid managed care plan the organization offers;
(2) the organization’s provider network includes:
(A) a sufficient number of primary care providers;
(B) a sufficient variety of provider types;
(C) a sufficient number of long-term services and supports providers and specialty pediatric care providers of home and community-based services; and
(D) providers located throughout the region in which the organization will provide health care services; and
(3) health care services will be accessible to recipients through the organization’s provider network to a comparable extent that health care services would be available to recipients under a fee-for-service model or primary care case management Medicaid managed care model.

Text of section effective on April 01, 2025