Common use of Waiting Maximums and Appointment Requirements Clause in Contracts

Waiting Maximums and Appointment Requirements. 4.8.14.1 The Contractor shall require that all network Providers offer hours of operation that are no less than the hours of operation offered to commercial and Fee-for-Service patients. The Contractor shall encourage its PCPs to offer After-Hours office care in the evenings and on weekends. 4.8.14.2 The Contractor shall have in its network the capacity to ensure that waiting times for appointments do not exceed the following: PCPs (routine visits) Not to exceed 14 calendar days PCP (adult sick visit) Not to exceed 24 hours PCP (pediatric sick visit) Not to exceed 24 hours Specialists Not to exceed 30 Calendar Days Dental Providers (routine visits) Not to exceed 21 Calendar Days Dental Providers (urgent care) Not to exceed 48 hours Elective Hospitalizations 30 Calendar Days Mental health Providers 14 Calendar Days Urgent Care Providers Not to exceed 24 hours Emergency Providers Immediately (24 hours a day, 7 days a week) and without prior authorization 4.8.14.3 The Contractor shall have in its network the capacity to ensure that waiting times in the provider office does not exceed the following for pediatrics and adults: Scheduled Appointments Waiting times shall not exceed 60 minutes. After 30 minutes, patient must be given an update on waiting time with an option of waiting or rescheduling appointment. Work-in or Walk-In Appointments Waiting times shall not exceed 90 minutes. After 45 minutes, patient must be given an update on waiting time with an option of waiting or rescheduling appointment 4.8.14.4 The Contractor shall ensure that provider response times for returning calls after-hours are as follows: Urgent Calls Shall not exceed 20 minutes Other Calls Shall not exceed one hour 4.8.14.5 The Contractor shall provide adequate capacity for initial visits for pregnant women within fourteen (14) Calendar Days and visits for Health Check eligible children within ninety (90) Calendar Days of Enrollment into the CMO plan. 4.8.14.6 The Contractor shall take corrective action if there is a failure to comply with these waiting times.

Waiting Maximums and Appointment Requirements. 4.8.14.1 The Contractor shall require that all network Providers offer hours of operation that are no less than the hours of operation offered to commercial and Fee-for-Service patients. The Contractor shall encourage its PCPs to offer After-Hours office care in the evenings and on weekends. 4.8.14.2 The Contractor shall have in its network the capacity to ensure that waiting times for appointments do not exceed the following: PCPs (routine visits) Not to exceed 14 calendar days PCP (adult sick visit) Not to exceed 24 hours PCP (pediatric sick visit) Not to exceed 24 hours Specialists Not to exceed 30 Calendar Days Dental Providers (routine visits) Not to exceed 21 Calendar Days Dental Providers (urgent care) Not to exceed 48 hours Elective Hospitalizations Non-emergency hospital stays 30 Calendar Days Mental health Providers 14 Calendar Days Urgent Care Providers Not to exceed 24 hours Emergency Providers Immediately (24 hours a day, 7 days a week) and without prior authorization 4.8.14.3 The Contractor shall have in its network the capacity to ensure that waiting times in the provider office does not exceed the following for pediatrics and adults: Scheduled Appointments Waiting times shall not exceed 60 minutes. After 30 minutes, patient must be given an update on waiting time with an option of waiting or rescheduling appointment. Work-in or Walk-In Appointments Waiting times shall not exceed 90 minutes. After 45 minutes, patient must be given an update on waiting time with an option of waiting or rescheduling appointment 4.8.14.4 The Contractor shall ensure that provider response times for returning calls after-hours are as follows: Urgent Calls Shall not exceed 20 minutes Other Calls Shall not exceed one hour 4.8.14.5 The Contractor shall provide adequate capacity for initial visits for pregnant women within fourteen (14) Calendar Days and visits for Health Check eligible children within ninety (90) Calendar Days of Enrollment into the CMO plan. 4.8.14.6 The Contractor shall take corrective action if there is a failure to comply with these waiting times.

Waiting Maximums and Appointment Requirements. ‌ 4.8.14.1 The Contractor shall require that all network Providers offer hours of operation that are no less than the hours of operation offered to commercial and Fee-for-for- Service patients. The Contractor shall encourage its PCPs to offer After-Hours office care in the evenings and on weekends. 4.8.14.2 The Contractor shall have in its network the capacity to ensure that waiting times for appointments do not exceed the following: PCPs (routine visits) Not to exceed 14 calendar days PCP (adult sick visit) Not to exceed 24 hours PCP (pediatric sick visit) Not to exceed 24 hours Specialists Not to exceed 30 Calendar Days Dental Providers (routine visits) Not to exceed 21 Calendar Days Dental Providers (urgent care) Not to exceed 48 hours Elective Hospitalizations 30 Calendar Days Mental health Providers 14 Calendar Days Urgent Care Providers Not to exceed 24 hours Emergency Providers Immediately (24 hours a day, 7 days a week) and without prior authorization 4.8.14.3 The Contractor shall have in its network the capacity to ensure that waiting times in the provider office does not exceed the following for pediatrics and adults: Scheduled Appointments Waiting times shall not exceed 60 minutes. After 30 minutes, patient must be given an update on waiting time with an option of waiting or rescheduling appointment. Work-in or Walk-In Appointments Waiting times shall not exceed 90 minutes. After 45 minutes, patient must be given an update on waiting time with an option of waiting or rescheduling appointment 4.8.14.4 The Contractor shall ensure that provider response times for returning calls after-after- hours are as follows: Urgent Calls Shall not exceed 20 minutes Other Calls Shall not exceed one hour 4.8.14.5 The Contractor shall provide adequate capacity for initial visits for pregnant women within fourteen (14) Calendar Days and visits for Health Check eligible children within ninety (90) Calendar Days of Enrollment into the CMO plan. 4.8.14.6 The Contractor shall take corrective action if there is a failure to comply with these waiting times.