Timely Access to Services. 1. Contractor shall meet State standards for timely access to care and services, taking into account the urgency of the need for services.
2. Contractor shall ensure that its hours of operations are no less than the hours of operation offered to commercial beneficiaries or comparable to Medicaid FFS, if Contractor serves only Medicaid beneficiaries.
3. Contractor shall make services included in this Agreement available 24 hours a day, 7 days a week, when medically necessary.
4. Contractor shall have policies and procedures in place to screen for emergency medical conditions and immediately refer beneficiaries to emergency medical care.
Timely Access to Services. Vendor shall ensure that Consumers are provided with an appointment within ten (10) business days of the requested date for Psychiatric Rehabilitation Services, unless the state, the federal government, or accreditation standards are more stringent. If a Consumer presents to Vendor with an emergency or crisis need, Vendor shall take immediate action, including any necessary outpatient follow- up care, and ensure clinical services are provided within one (1) business day of the request.
Timely Access to Services. In accordance with 42 CFR 438.206, the Contractor shall:
1. Meet standards for timely access to care and services, taking into consideration the urgency of need for services. Contractor shall attempt to provide first service for routine referrals within 10 business and within 48 hours for referrals determined to be urgent as outlined in Department Policy # 2.001 -
Timely Access to Services. Provider shall ensure that Consumers are provided with an appointment within ten (10) business days of the requested date for services. If a Consumer presents to Provider with an emergent or crisis need, Provider shall take immediate action, including ensuring necessary outpatient follow-up care, and ensure that clinical services are provided within one (1) business day of the request.
Timely Access to Services. The Contractor shall ensure compliance with the timely access requirements as referenced in 42 C.F.R. § 438.206(c)(1)(iv).
a. Contractor shall return phone calls to an authorized client within one (1) business day. Contractor shall offer an available initial visit with an authorized client within five (5) business days of the client's request for an appointment. The client must be seen within ten (10) business days of the request for an appointment.
b. The County shall monitor Contractor regularly to determine compliance with timely access requirements. (42 C.F.R. § 438.206(c)(1)(v).
c. The County shall work with the Contractor to improve timely access and/or take corrective action if there is a failure to comply with timely access requirements. (42 C.F.R. § 438.206(c)(1)(vi).
Timely Access to Services. When a call is received through the Access Line, CONTRACTOR shall determine and document in Access Log if the request for services is emergent, urgent, or routine.
a. If the caller’s needs are indicated as requiring emergent or urgent care, CONTRACTOR shall make a referral to COUNTY’s CAT or COUNTY Mental Health Outpatient Clinic without delay to prevent further decompensation or compromise of the member’s condition. CONTRACTOR shall at no time refer callers to inpatient care and must follow COUNTY criteria for inpatient assessment.
1) Emergent services shall be indicated when the Beneficiary has a psychiatric condition that meets COUNTY’s criteria for acute psychiatric hospitalization and cannot be treated at a lower level of care. These criteria include the Beneficiary being a danger to himself/herself or others or an immediate inability of the Beneficiary to provide for, or utilize food, shelter or clothing as a result of a mental disorder. These calls must be provided warm- linkage to the COUNTY OC Links / Crisis Assessment Team for further evaluation and treatment.
2) Urgent services shall be indicated when a situation experienced by a Beneficiary that, without timely intervention, is highly likely to result in an immediate emergency psychiatric condition. Beneficiaries in need of urgent services shall receive timely mental health intervention that shall be appropriate to the severity of the condition. Linkage for these services must be within twenty-four (24) hours.
3) CONTRACTOR must obtain confirmation that any caller assessed as requiring emergent or urgent care has been appropriately connected to COUNTY or emergency services. If the Beneficiary did not show up to the appointed session/evaluation, CONTRACTOR shall contact the Beneficiary to further facilitate services.
4) Appointment standards regarding emergent and urgent care shall be communicated to Network Providers as part of the Network Provider handbook and shall be incorporated in their Network Provider contractual Contract with CONTRACTOR.
b. If the caller’s needs are indicated as requiring routine care, CONTRACTOR shall make a referral to COUNTY for an appointment to be offered within ten (10) business days of the referral. Routine services shall be indicated when a Beneficiary’s mental health needs are not urgent, but for whom mental health services of some type can improve functioning and/or reduce symptoms, or for whom mental health services are necessary to maintain his or her highes...
