Written Standards for Accessibility of Care. The HMO must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the HMO. The standards must include the following: Waiting times for care at facilities; waiting times for appointments; statement that providers’ hours of operation do not discriminate against Medicaid and BadgerCare enrollees; and whether or not provider(s) speak member’s language. The HMO must take corrective action if its standards are not met.
Written Standards for Accessibility of Care.
1. The PIHP must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the PIHP. The standards must include the following:
a. Waiting times for care at facilities;
b. Waiting times for appointments;
c. Statement that providers’ hours of operation do not discriminate against FCMH members; and
d. Whether or not provider(s) speak the member’s language.
2. The PIHP’s standards for waiting times for appointments must be as follows for the indicated provider types:
a. To be no longer than 30 days for an appointment with a PCP;
b. To be no longer than 30 days for an appointment with a Mental Health provider for follow-up after an inpatient mental health stay;
c. To be no longer than 90 days for an appointment with a dental provider for a routine dental appointment in regions 5 and 6.
3. The PIHP may not prohibit, or otherwise restrict, a health care professional acting within the lawful scope of practice, from advising or advocating on behalf of an enrollee who is his or her patient, for the following:
a. The enrollee's health status, medical care, or treatment options, including any alternative treatment that may be self-administered.
b. Any information the enrollee needs in order to decide among all relevant treatment options.
c. The risks, benefits, and consequences of treatment or nontreatment.
d. The enrollee's right to participate in decisions regarding his or her health care, including the right to refuse treatment, and to express preferences about future treatment decisions. These minimum requirements shall not release the PIHP from the requirement to provide or arrange for the provision of any medically necessary covered service required by its members. The PIHP must take corrective action if its standards are not met.
Written Standards for Accessibility of Care. 1. The HMO must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the HMO. The standards must include the following: Waiting times for care at facilities; Waiting times for appointments; Statement that providers’ hours of operation do not discriminate against BadgerCare Plus and/or Medicaid SSI members; and Whether or not provider(s) speak the member’s language.
2. The HMO’s standards for waiting times for appointments must be as follows for the indicated provider types: To be no longer than 30 days for an appointment with a PCP; To be no longer than 30 days for an appointment with a Mental Health provider for follow-up after an inpatient mental health stay. To be no longer than 90 days for an appointment with a dental provider for a routine dental appointment in regions 5 and 6. These minimum requirements shall not release the HMO from the requirement to provide or arrange for the provision of any medically necessary covered service required by its members. The HMO must take corrective action if its standards are not met.
Written Standards for Accessibility of Care. The HMO must have written standards for the accessibility of care and services. These standards must be communicated to providers and monitored by the HMO. The standards must include the following: • Waiting times for care at facilities; • Waiting times for appointments; • Statement that providers’ hours of operation do not discriminate against BadgerCare Plus and/or Medicaid SSI members; and • Whether or not provider(s) speak the member’s language. The HMO’s standards for waiting times for appointments must be as follows for the indicated provider types:
a. BadgerCare Plus and Medicaid SSI HMOs (Regions 1-6) • To be no longer than 30 days for an appointment with a PCP; • To be no longer than 30 days for an appointment with a Mental Health provider for follow-up after an inpatient mental health stay.
b. BadgerCare Plus HMOs and Medicaid SSI (Regions 5 & 6) • To be no longer than 90 days for an appointment with a dental provider for a routine dental appointment. These minimum requirements shall not release the HMO from the requirement to provide or arrange for the provision of any medically necessary covered service required by its members. The HMO must take corrective action if its standards are not met.
