Appointment Waiting Times and Geographic Access Standards. 1. The Health Plan must assure that PCP services and referrals to specialists for covered services are available on a timely basis, as follows:
a. Urgent Care — within one (1) day,
b. Routine Sick Patient Care — within one (1) week, and
c. Well Care Visit — within one (1) month.
2. All PCPs, hospital and community mental health services must be available within an average of thirty (30) minutes’ travel time from an enrollee's residence. All participating specialists and ancillary providers must be within an average of sixty (60) minutes’ travel time from an enrollee's residence. BMHC may waive this requirement, in writing, for rural areas and for areas where there are no PCPs, hospitals or community mental health centers within a thirty (30) minute average travel time.
3. The Health Plan shall provide a designated emergency services facility within an average of thirty (30) minutes’ travel time from an enrollee's residence, that provides care on a twenty-four hours a day, seven days a week (24/7) basis. Each designated emergency service facility shall have one (1) or more physicians and one (1) or more nurses on duty in the facility at all times. BMHC may waive the travel time requirement, in writing, in rural areas.
4. For rural areas, if the Health Plan is unable to enter into an agreement with specialty or ancillary service providers within the required sixty (60) minute average travel time, BMHC may waive, in writing, the requirement.
5. At least one (1) pediatrician or one (1) CHD, FQHC or RHC must be available within an average of thirty (30) minutes’ travel time from an enrollee's residence, provided that this requirement remains consistent with the other minimum time requirements of this Contract. In order to meet this requirement, the pediatrician(s), CHD, FQHC, and/or RHC must provide access to care on a twenty-four hour a day, seven day a week (24/7) basis. BMHC may waive this requirement, in writing, for rural areas and where there are no pediatricians, CHDs, FQHCs or RHCs within the thirty (30) minute average travel time.
6. Annually by February 1 of each Contract year, the Health Plan shall review a statistically valid sample of PCP offices’ average appointment wait times to ensure services are in compliance with Attachment II, Section VII, Provider Network, Item F., Appointment Waiting Times and Geographic Access Standards, and report the results to BMHC in the format specified, in accordance with Attachment II, Section XII, Reporting Requir...
Appointment Waiting Times and Geographic Access Standards. 1. The Health Plan must assure that PCP services and referrals to participating specialists are available on a timely basis, as follows:
a. Urgent Care — within one (1) day,
b. Routine Sick Patient Care — within one (1) week, and WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract
c. Well Care Visit — within one (1) month.
2. All PCPs, hospital and community mental health services must be available within an average of thirty (30) minutes’ travel time from an enrollee's residence. All participating specialists and ancillary providers must be within an average of sixty (60) minutes’ travel time from an enrollee's residence. BMHC may waive this requirement, in writing, for rural areas and for areas where there are no PCPs, hospitals or community mental health centers within a thirty (30) minute average travel time.
3. The Health Plan shall provide a designated emergency services facility within an average of thirty (30) minutes’ travel time from an enrollee's residence, that provides care on a twenty-four hours a day, seven days a week (24/7) basis. Each designated emergency service facility shall have one (1) or more physicians and one (1) or more nurses on duty in the facility at all times. BMHC may waive the travel time requirement, in writing, in rural areas.
4. For rural areas, if the Health Plan is unable to enter into an agreement with specialty or ancillary service providers within the required sixty (60) minute average travel time, BMHC may waive, in writing, the requirement.
5. At least one (1) pediatrician or one (1) CHD, FQHC or RHC must be available within an average of thirty (30) minutes’ travel time from an enrollee's residence, provided that this requirement remains consistent with the other minimum time requirements of this Contract. In order to meet this requirement, the pediatrician(s), CHD, FQHC, and/or RHC must provide access to care on a twenty-four hour a day, seven day a week (24/7) basis. BMHC may waive this requirement, in writing, for rural areas and where there are no pediatricians, CHDs, FQHCs or RHCs within the thirty (30) minute average travel time.
6. Annually by February 1 of each Contract year, the Health Plan shall review a statistically valid sample of PCP offices’ average appointment wait times to ensure services are in compliance with Attachment II, Section VII, Provider Network, Item F., Appointment Waiting Times and Geographic Access Standards, and report the results to BMH...
