Timely Access. 36.1. CONTRACTOR shall comply with the requirements set forth in CCR, Title 9, § 1810.405, including meeting COUNTY and State Contract standards for timely access to care and services, taking into account the urgency of need for services. The COUNTY shall monitor CONTRACTOR to determine compliance with timely access requirements and shall take corrective action in the event of noncompliance.
36.2. Timely access standards include:
36.2.1. CONTRACTOR must have hours of operation during which services are provided to Medi-Cal clients that are no less than the hours of operation during which the provider offers services to non-Medi-Cal clients. If the CONTRACTOR’S provider only serves Medi-Cal clients, the provider must provide hours of operation comparable to the hours the provider makes available for Medi-Cal services that are not covered by the Agreement or another County.
36.2.2. Appointments data, including wait times for requested services, must be recorded and tracked by CONTRACTOR, and submitted to the COUNTY on a monthly basis in a format specified by the COUNTY. Appointments’ data should be submitted to the COUNTY’S Quality Management Department or other designated persons.
36.2.3. Xxxxxx care appointments for services that do not require prior authorization must be provided to clients within 48 hours of a request. Urgent appointments for services that do require prior authorization must be provided to clients within 96 hours of request.
36.2.4. Non-urgent non-psychiatry mental health services, including, but not limited to Assessment, Targeted Case Management, and Individual and Group Therapy appointments (for both adult and children/youth) must be made available to Medi-Cal clients within 10 business days from the date the client or a provider acting on behalf of the client, requests an appointment for a medically necessary service. Non-urgent psychiatry appointments (for both adult and children/youth) must be made available to Medi-Cal clients within 15 business days from the date the client or a provider acting on behalf of the client, requests an appointment for a medically necessary service.
36.2.5. Applicable appointment time standards may be extended if the referring or treating provider has determined and noted in the client’s record that a longer waiting period will not have a detrimental impact on the health of the client.
36.2.6. Periodic office visits to monitor and treat mental health conditions may be scheduled in advance consistent wi...
Timely Access. (A) The Contractor and its Network Providers shall meet the Department’s standards for timely access to Covered Services, as described in Article 10.4 of this attachment, taking into account the urgency of the need for services.
(B) The Contractor's shall ensure its Network Providers offer hours of operation that are no less than the hours of operation offered to commercial enrollees or are comparable to Medicaid FFS enrollees, if the Network Provider serves only Medicaid Enrollees.
(C) The Contractor shall make all Covered Services available 24 hours a day, 7 days a week, when Medically Necessary.
Timely Access. The Contractor shall require that its Participating Providers offer hours of operation that are no less than the hours of operation offered to commercial enrollees or Medicaid Fee-For-Service enrollees, if the Participating Provider serves only Medicaid Enrollees. The Contractor shall ensure that all Covered Services are available 24 hours a day, 7 days a week, when Medically Necessary.
Timely Access. A. In accordance with 42 CFR 438.206(c)(1), the Contractor shall comply with the following requirements:
1) Meet and require its providers to meet DHCS standards for timely access to care and services, taking into account the urgency of need for services;
2) Require subcontracted providers to have hours of operation during which services are provided to Medi-Cal beneficiaries that are no less than the hours of operation during which the provider offers services to non-Medi-Cal beneficiaries. If the provider only serves Medi-Cal beneficiaries, the Contractor shall require that hours of operation are comparable to the hours the provider makes available for Medi-Cal services that are not covered by the Contractor;
3) Make services available to beneficiaries 24 hours a day, 7 days a week, when medically necessary;
4) Establish mechanisms to ensure that network providers comply with the timely access requirements;
5) Monitor network providers regularly to determine compliance with timely access requirements; and
6) Take corrective action if there is a failure to comply with timely access requirements.
Timely Access. A revocation process or other specified remedies for providers whose performance is unacceptable in one or more of the areas noted in Section 2.7.B.1.d. above. For serious Complaints involving medical provider errors, the Contractor must take immediate corrective action and file reports of corrections made with CMS and MassHealth within three business days of the Complaint.
Timely Access. A. In accordance with 42 CFR 438.206 (c)(1), the Contractor shall comply with the following requirements:
1. Meet DHCS standards for timely access to care and services, taking into account the urgency of need for services, including making services available to beneficiaries 24 hours a day, 7 days a week, when medically necessary.
2. Have hours of operation during which services are provided to Medi-Cal beneficiaries that are no less than the hours of operation during which the provider offers services to non-Medi-Cal beneficiaries.
3. The Contractor will establish mechanisms to ensure that their capacity, referral, and intake procedures comply with the timely access requirements; and take corrective action if there is failure to comply with timely access requirements.
Timely Access. The Contractor shall require that its Participating Providers offer hours of operation that are no less than the hours of operation offered to commercial enrollees.
Timely Access. Provider shall meet Agency standards for timely access to care and services, taking into account the urgency of the need for services. Provider shall offer hours operation to Members that are no less than the hours of operation offered to commercial enrollees or comparable to Medicaid fee-for-service, if Provider serves only Medicaid enrollees. Provider services shall be available 24 hours a day, 7 days a week, when medically necessary. Provider shall provide physical access, reasonable accommodations, and accessible equipment for Members with physical or mental disabilities. 42 CFR §438.206(c).
Timely Access. A. Timely Access. In accordance with 42 C.F.R. § 438.206(c)(1), the Contractor shall:
1) Meet and require its providers to meet standards for timely access to care and services, taking into account the urgency of need for services, pursuant to Welf. & Inst. Code section 14197(d), as specified in BHIN 21-023 and its enclosures, or in subsequent, guidance issued by the Department.
2) Comply with the timeliness standards specified in Cal. Code Regs., tit. 9, section 1810.405(c) and Welf. & Inst. Code § 14717.1. Those standards apply to out-of-plan services, as well as in-plan services.
3) Require subcontracted providers to have hours of operation during which services are provided to Medi-Cal beneficiaries that are no less than the hours of operation during which the provider offers services to non-Medi-Cal beneficiaries. If the provider only serves Medi-Cal beneficiaries, the Contractor shall require that hours of operation are comparable to the hours the provider makes available for Medi-Cal services that are not covered by the Contractor, or another Mental Health Plan.
4) Make services available to beneficiaries 24 hours a day, 7 days a week, when medically necessary.
5) Establish mechanisms to ensure that network providers comply with the timely access requirements;
6) Monitor network providers regularly to determine compliance with timely access requirements;
7) Take corrective action if there is a failure to comply with timely access requirements by a network provider.
Timely Access. Customers much ensure that remote access is available prior to notifying USDD of a support request. In the event that the Customer is unable to provide remote access, USDD will not be required to provide support outside those tasks that do not require remote access, and any corresponding resolution response times will not apply.
