Common use of TIMELY ACCESS REQUIREMENTS Clause in Contracts

TIMELY ACCESS REQUIREMENTS. 14.1 Contractor shall comply with the requirements set forth in CCR, Title 9, § 1810.405, including meeting MHP and State Contract standards for timely access to care and services, taking into account the urgency of need for services. The MHP shall monitor Contractor/MHP network providers to determine compliance with timely access requirements and shall take corrective action in the event of noncompliance. 14.2 Timely access standards include: 14.2.1 Contractors must have hours of operation during which services are provided to Medi-Cal beneficiaries that are no less that the hours of operation during which the provider offers services to non-Medi-Cal beneficiaries. If the Contract agency provider only serves Medi-Cal beneficiaries, the contracted agency must provide hours of operation comparable to the hours the provider makes available for Medi-Cal services that are not covered by the Contract or another Mental Health Plan. 14.2.2 Appointments data, including wait times for requested services, must be recorded and tracked by Contractor, and submitted to the MHP’ on a monthly basis in a format specified by the MHP. Appointments’ data should be submitted to the MHP’s Quality Management via email to XXXXXXXxxxxx@xxxxxxxxxxx.xxx. 14.2.3 Urgent care appointment for services that do not require prior authorization must be provided to beneficiaries within 48 hours of a request. Urgent appointments for services that do require prior authorization must be provided to beneficiaries within 96 hours of request. 14.2.4 Non-urgent Mental Health Services, including Initial Assessment, Targeted Case Management, Crisis Intervention and Medication Support Service appointments (for both adult and children/youth) must be made available to Medi-Cal beneficiaries within 10 business days from the date the beneficiary or a provider acting on behalf of the beneficiary, requests an appointment for a medically necessary service. Medical necessity shall be determined at an initial assessment appointment which shall be made available within 10 business days of request. Medical necessity must be established before other services can be provided. 14.2.5 Non-urgent psychiatry appointments (for both adult and children/youth) must be made available to Medi-Cal beneficiaries within 15 business days from the date the beneficiary or a provider acting on behalf of the beneficiary, requests an appointment for a medically necessary service. 14.2.6 Applicable appointment time standards may be extended if the referring or treating provider has determined and noted in the beneficiary’s record that a longer waiting period will not have a detrimental impact on the health of the beneficiary. 14.2.7 Periodic office visits to monitor and treat mental health conditions may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed mental health provider acting within the scope of his or her practice.

TIMELY ACCESS REQUIREMENTS. 14.1 Contractor shall comply with the requirements set forth in CCR, Title 9, § 1810.405, including meeting MHP and State Contract standards for timely access to care and services, taking into account the urgency of need for services. The MHP shall monitor Contractor/MHP network providers to determine compliance with timely access requirements and shall take corrective action in the event of noncompliance. 14.2 Timely access standards include: 14.2.1 Contractors must have hours of operation during which services are provided to Medi-Cal beneficiaries that are no less that the hours of operation during which the provider offers services to non-Medi-Cal beneficiaries. If the Contract agency provider only serves Medi-Cal beneficiaries, the contracted agency must provide hours of operation comparable to the hours the provider makes available for Medi-Cal services that are not covered by the Contract or another Mental Health Plan. 14.2.2 Appointments Appointment data, including wait times for requested services, must be recorded and tracked by Contractor, and submitted to the MHP’ on a monthly basis in a format specified by the MHP. Appointments’ data should be submitted to the MHP’s Quality Management via email to XXXXXXXxxxxx@xxxxxxxxxxx.xxx. 14.2.3 Urgent care appointment for services that do not require prior authorization must be provided to beneficiaries within 48 hours of a request. Urgent appointments for services that do require prior authorization must be provided to beneficiaries within 96 hours of request. 14.2.4 Non-urgent Mental Health Services, including Initial Assessment, Targeted Case Management, Crisis Intervention and Medication Support Service appointments (for both adult and children/youth) must be made available to Medi-Cal beneficiaries within 10 business days from the date the beneficiary or a provider acting on behalf of the beneficiary, requests an appointment for a medically necessary service. Medical necessity shall be determined at an initial assessment appointment which shall be made available within 10 business days of request. Medical necessity must be established before other services can be provided. 14.2.5 Non-urgent psychiatry appointments (for both adult and children/youth) must be made available to Medi-Cal beneficiaries within 15 business days from the date the beneficiary or a provider acting on behalf of the beneficiary, requests an appointment for a medically necessary service. 14.2.6 Applicable appointment time standards may be extended if the referring or treating provider has determined and noted in the beneficiary’s record that a longer waiting period will not have a detrimental impact on the health of the beneficiary. 14.2.7 Periodic office visits to monitor and treat mental health conditions may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed mental health provider acting within the scope of his or her practice.