Appointment Standards. The Contractor shall comply with appointment standards that are no longer than the following (42 C.F.R. § 438.206(c)(1)(i)):
Appointment Standards. Applicants for appointment to the classified staff shall fulfill the requirements and meet the standards as defined in the job description approved by the Governing Board. In addition, they shall submit to fingerprinting prior to employment pursuant to Board Policy 4112.5, 4212.5 and Administrative Regulation 4212.5(a).
Appointment Standards. The Contractor shall monitor appointment availability utilizing the methodology found in ACOM Policy 417 to ensure that the following standards are met: For purposes of this section, "urgent" is defined as an acute, but not necessarily life-threatening disorder, which, if not attended to, could endanger the patient’s health. The Contractor shall have procedures in place that ensure the following standards are met. For Primary Care Appointments, the Contractor shall be able to provide:
a. Emergency appointments the same day or within 24 hours of the member’s phone call or other notification
b. Urgent care appointments within 2 days of request
Appointment Standards. The Contractor shall comply with appointment standards that are consistent with the following:
6.2.1. The Contractor shall make available behavioral health services on a twenty-four (24) hour, seven (7) days per week basis when clinically indicated and medically necessary.
6.2.1.1. Urgent care must occur within twenty-four (24) hours of a request for mental health services from any source.
6.2.2. A routine behavioral health intake evaluation or assessment appointment must be available and offered to every Enrollee within ten (10) business days of the request, with a possible extension of up to an additional ten (10) business days, unless both of the following conditions are met:
6.2.2.1. An intake evaluation has been provided in the previous twelve (12) months that establishes medical necessity and
6.2.2.2. The Contractor agrees to use the previous intake evaluation as the basis for the request for authorization.
6.2.3. The time period from request for behavioral health services to first offered Routine Services appointment must not exceed twenty-eight
Appointment Standards. The Contractor must comply with appointment standards that are consistent with the following:
Appointment Standards. 93 13. Policies and Procedures for Appointment Standards.........................................96 14.
Appointment Standards. The Contractor agrees to require the PCP, dentist, or specialist to conduct affirmative outreach whenever a Member misses an appointment and to document this in the medical record. Such an effort shall be deemed to be reasonable if it includes three (3) attempts to contact the Member. Such attempts may include, but are not be limited to: written attempts, telephone calls and home visits. At least one (1) such attempt must be written.
a. GENERAL PCP scheduling procedures must ensure that:
i. Emergency cases must be seen or referred to an emergency facility. If it is determined that Emergency Medical Condition care is not required, the Member must be seen by the PCP or referred to an open urgent care clinic.
ii. Urgent Medical Condition cases must be scheduled within twenty-four (24) hours.
iii. Routine appointments must be scheduled within ten (10) business days.
iv. Health assessment/general physical examinations and first examinations must be scheduled within three (3) weeks of enrollment.
v. The Contractor must provide the Department with its protocol for ensuring that a Member's average office waiting time is no more than twenty (20) minutes or at any time no more than up to one (1) hour when the physician encounters an unanticipated Urgent Medical Condition visit or is treating a Member with a difficult medical need. The Member will be informed of scheduling time frames through educational outreach efforts.
vi. The Contractor must monitor the adequacy of its appointment processes and reduce the unnecessary use of emergency room visits.
Appointment Standards. The Contractor shall comply with appointment standards that are no longer than the following (42 CFR 438.206(c)(1)(i)):
7.7.1. Non-symptomatic (i.e., preventive care) office visits shall be available from the enrollee’s PCP or another provider within thirty (30) calendar days. A non-symptomatic office visit may include, but is not limited to, well/preventive care such as physical examinations, annual gynecological examinations, or child and adult immunizations.
7.7.2. Non-urgent, symptomatic (i.e., routine care) office visits shall be available from the enrollee’s PCP or another provider within ten (10) calendar days. A non-urgent, symptomatic office visit is associated with the presentation of medical signs not requiring immediate attention.
7.7.3. Urgent, symptomatic office visits shall be available from the enrollee’s PCP or another provider within forty-eight (48) hours. An urgent, symptomatic visit is associated with the presentation of medical signs that require immediate attention, but are not life threatening.
7.7.4. Emergency medical care shall be available twenty-four (24) hours per day, seven (7) days per week.
Appointment Standards. The Contractor must comply with appointment standards that are consistent with the followlng:
8.2.1 The Contractor must make available crisis behavioral health services on a twenty-four
Appointment Standards. The Contractor shall comply with appointment standards that are consistent with the following:
6.2.1. The Contractor shall make available behavioral health services on a twenty-four (24) hour, seven (7) days per week basis when clinically indicated and medically necessary.
6.2.1.1. Urgent care must occur within twenty-four (24) hours of a request for mental health services from any source.
6.2.2. The Contractor shall assist Individuals being discharged from a psychiatric inpatient stay or residential substance use disorder treatment stay to receive outpatient behavioral health services within seven (7) calendar days of discharge.
6.2.3. If behavioral health services are not rendered within these guidelines, the Contractor should monitor the reason and appropriateness of the delay as documented in the clinical record. This can include documentation that there were no appropriate Available Resources as allowed under this Agreement or that the Individual did not meet the definition of a priority group for substance use disorder treatment as defined in this Agreement.
6.2.4. The Contractor must ensure that medical necessity is established and documented and that Access to Care Standards for mental health and/or substance use disorders have been met. Once medical necessity has been established and documented, the Contractor shall review client records to ensure that:
6.2.4.1. Authorized services are appropriate for the diagnosis;
6.2.4.2. The individualized service plan reflects the identified needs, including amount, duration, and scope of the services; and
6.2.4.3. Progress notes support the use of each authorized state- plan service.
6.2.5. The Contractor shall monitor client records prior to authorization request to review that within one hundred eighty (180) days or sooner based on program specific requirements, the service plan, current diagnostic information and provided justification for level of continued treatment have been reviewed and updated as appropriate.
