Common use of Waiting Times for Appointments Clause in Contracts

Waiting Times for Appointments. Through its Provider Network composition and management, the MCO must ensure that the following standards are met. In all cases below, "day" is defined as a calendar day, and the standards are measured from the date of presentation or request, whichever occurs first. 1. Emergency Services must be provided upon Member presentation at the service delivery site, including at non-network and out-of-area facilities; 2. urgent care, including urgent specialty care, must be provided within 24 hours; 3. routine primary care must be provided within 14 days; 4. initial outpatient behavioral health visits must be provided within 14 days; 5. PCPs must make referrals for specialty care on a timely basis, based on the urgency of the Member's medical condition, but no later than 30 days; 6. pre-natal care must be provided within 14 days, except for high-risk pregnancies or new Members in the third trimester, for whom an appointment must be offered within five days, or immediately, if an emergency exists; 7. preventive health services for adults must be offered within 90 days; and 8. preventive health services for children, including well-child checkups should be offered to CHIP Members in accordance with the American Academy of Pediatrics (AAP) periodicity schedule. Medicaid MCOs should utilize the Texas Health Steps periodicity schedule. For a New Member birth through age 20, overdue or upcoming well-child checkups, including Texas Health Steps medical checkups, should be offered as soon as practicable, but in no case later than 14 days of enrollment for newborns, and no later than 90 days of enrollment for all other eligible child Members. The Texas Health Steps annual medical checkup for an Existing Member age 36 months and older is due on the child's birthday. The annual medical checkup is considered timely if it occurs no later than 364 calendar days after the child's birthday. For purposes of this requirement, the terms "New Member" and "Existing Member" are defined in Chapter 12.4 of the Uniform Managed Care Manual.

Waiting Times for Appointments. Through its Provider Network composition and management, the MCO HMO must ensure that appointments for the following standards types of Covered Services are metprovided within the time frames specified below. In all cases below, "“day" ” is defined as a calendar day, and the standards are measured from the date of presentation or request, whichever occurs first. 1. Emergency Services must be provided upon Member presentation at the service delivery site, including at non-network and out-of-area facilities; 2. urgent Urgent care, including urgent specialty care, must be provided within 24 hours;hours of request. 3. routine Routine primary care must be provided within 14 daysdays of request; 4. initial Initial outpatient behavioral health visits must be provided within 14 daysdays of request; 5. PCPs must make referrals for Routine specialty care on a timely basis, based on the urgency referrals must be provided within 30 days of the Member's medical condition, but no later than 30 daysrequest; 6. prePre-natal care must be provided within 14 daysdays of request, except for high-risk pregnancies or new Members in the third trimester, for whom an appointment must be offered within five days, or immediately, if an emergency exists; 7. preventive Preventive health services for adults must be offered to a Member within 90 daysdays of request; and 8. preventive Preventive health services for children, including well-child checkups should be offered to CHIP Members in accordance with the American Academy of Pediatrics (AAP) periodicity schedule. Medicaid MCOs HMOs should utilize the Texas Health Steps periodicity schedule. For a New Member birth through Members under age 2021, overdue or upcoming well-child checkups, including Texas Health Steps medical checkups, should be offered as soon as practicable, but in no case later than 14 days of enrollment for newborns, and no later than 90 days of enrollment for all other eligible child Members. The Effective September 1, 2010, the Texas Health Steps annual medical checkup for an Existing Member age 36 months and older is due on the child's ’s birthday. The annual medical checkup is considered timely if it occurs no later than 364 calendar days after the child's ’s birthday. For purposes of this requirement, the terms "“New Member" ” and "“Existing Member" ” are defined in Chapter 12.4 of the Uniform Managed Care Manual.

Waiting Times for Appointments. Through its Provider Network composition and management, the MCO must ensure that appointments for the following standards types of Covered Services are metprovided within the following timeframes. In all cases below, "“day" ” is defined as a calendar day, and the standards are measured from the date of presentation or request, whichever occurs first. 1. Emergency Services must be provided upon Member presentation at the service delivery site, including at non-network and out-of-area facilities; 2. urgent care, including urgent specialty care, must be provided within 24 hours;hours of request. 3. routine primary care must be provided within 14 daysdays of request; 4. initial outpatient behavioral health visits must be provided within 14 daysdays of request; 5. PCPs must make referrals for routine specialty care on a timely basis, based on the urgency referrals must be provided within 30 days of the Member's medical condition, but no later than 30 daysrequest; 6. pre-natal care must be provided within 14 daysdays of request, except for high-risk pregnancies or new Members in the third trimester, for whom an appointment must be offered within five (5) days, or immediately, if an emergency exists; 7. preventive health services for adults must be offered to a Member within 90 daysdays of request; and 8. preventive health services for children, including well-child checkups should be offered to CHIP Members in accordance with the American Academy of Pediatrics (AAP) periodicity schedule. Medicaid MCOs should utilize the Texas Health Steps periodicity schedule. For a New Member birth through age 20, overdue or upcoming well-child checkups, including Texas Health Steps medical checkups, should be offered as soon as practicable, but in no case later than 14 days of enrollment for newborns, and no later than 90 days of enrollment for all other eligible child Members. The Texas Health Steps annual medical checkup for an Existing Member age 36 months and older is due on the child's ’s birthday. The annual medical checkup is considered timely if it occurs no later than 364 calendar days after the child's ’s birthday. For purposes of this requirement, the terms "“New Member" ” and "“Existing Member" ” are defined in Chapter 12.4 of the Uniform Managed Care Manual.