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Take it freeThe complete time and distance standards for Medicare Advantage, Medicaid, Exchange/QHP, and D-SNP networks — with county type breakdowns, access exception rules, and practical guidance.
Standards based on CMS 2025 MA network adequacy final rule and state Medicaid managed care guidance. Verify current year standards before filing.
CMS uses the lesser of the two. If you meet the time standard but not the distance standard (or vice versa), you must meet BOTH. Blueprint evaluates each independently and flags a county adequate only when both are satisfied.
Counties are classified as urban, suburban, rural, or frontier based on RUCA (Rural-Urban Commuting Area) codes. Classification determines which threshold applies. Blueprint auto-assigns RUCA codes at the county level.
CMS uses drive time for time standards and straight-line distance for distance standards. Both are calculated from the enrollee's residence to the nearest in-network provider of that specialty.
CMS-regulated standards apply uniformly across all MA and MA-PD plans. Standards are enforced by county and measured against the plan's contracted in-network provider locations. Frontier thresholds apply to counties with fewer than 7 persons per square mile.
| Provider Type | Urban | Suburban | Rural | Frontier | Notes |
|---|---|---|---|---|---|
| Primary Care | 15 min / 10 mi | 30 min / 20 mi | 60 min / 60 mi | 90 min / 90 mi | — |
| OB/GYN | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Behavioral Health (MH/SUD) | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Cardiology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Dermatology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| ENT / Otolaryngology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Endocrinology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Gastroenterology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| General Surgery | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Infectious Disease | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Mental Health (Psychiatry) | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Nephrology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Neurology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Oncology (Medical / Surgical / Radiation) | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | Medical, surgical, and radiation tracked separately |
| Ophthalmology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Orthopedics | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Physical / OT / Speech Therapy | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Podiatry | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Pulmonology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Rheumatology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Urology | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Skilled Nursing Facility (SNF) | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Home Health Agency (HHA) | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
| Diagnostic Radiology (Imaging) | 30 min / 15 mi | 45 min / 30 mi | 75 min / 75 mi | 90 min / 90 mi | — |
Row shading: blue = primary care; gray = facility / ancillary; white = specialist. Standards shown as drive time / straight-line distance.
Governing rule: 42 CFR Part 438 — state-specific access standards
Urban / Rural (state-defined)
State Medicaid agencies grant exceptions; documentation requirements vary by state. Contact your state MCO liaison for the current exception template.
State-specific standards may exceed federal minimums. Always verify current state guidance before filing. Blueprint surfaces state-specific overrides where data is available.
Governing rule: 45 CFR Part 156 — QHP certification standards
Urban / Rural (varies by state/exchange)
QHP access exceptions are reviewed by the state insurance commissioner or CMS for FFE states. Mental health parity exceptions require additional documentation.
State-specific standards may exceed federal minimums. Always verify current state guidance before filing. Blueprint surfaces state-specific overrides where data is available.
Governing rule: MA standards apply + state MOU requirements
Urban / Suburban / Rural / Frontier
D-SNP plans must document exceptions under both the MA framework (CMS) and the state MOU terms. Dual documentation is required — a single CMS exception filing does not satisfy state requirements.
D-SNP plans reference both the CMS MA final rule and state MOU exhibit standards. Blueprint tracks both sets of requirements simultaneously.
Access exceptions let plans demonstrate reasonable efforts to meet standards when no in-network provider exists within the required distance — but they come with strict documentation requirements and limits.
CMS updates network adequacy standards annually in the MA Call Letter and final rule. Standards listed here reflect the 2025 final rule. Always verify against the current year’s CMS guidance before your network adequacy filing. Blueprint automatically applies updated thresholds at the start of each new benefit year.
Blueprint scores your contracted network against every county, every specialty, and every county type — surfacing gaps, exception candidates, and recruiting priorities in one unified view. No spreadsheets required.