Access to Care Standards

Posted on October 9th, 2023 in Bulletin Board by CHPW Admin

CHPW members should have timely access to adequate and appropriate care based on approved accessibility standards. Access to Care Standards have been developed to ensure that all health care services are provided in a timely manner. CHPW and its provider network must meet regulatory access-to-care standards outlined as follows:

Type of Appointment	Scheduling Time Frame
All Providers
Emergency Care	Immediately, and available 24/7
Transitional visit (clinical assessment or care planning)	Within seven (7) calendar days of member’s discharge from an inpatient or behavioral health facility or substance use disorder treatment program.
Second Opinion	Within thirty (30) calendar days of the request unless the Enrollee requests a postponement of the second opinion to a date later than thirty (30) calendar days.
PCP, OB/GYN, Midwife
Preventative office visit – non-symptomatic	Within thirty (30) calendar days
Non-urgent routine office visit – symptomatic	Within ten (10) calendar days
Urgent office visit – symptomatic	Within twenty-four (24) hours
Behavioral Health Providers
Care for a non-life-threatening emergency	Within six (6) hours
Urgent office visit – symptomatic	Within twenty-four (24) hours
Non-urgent routine office visit – symptomatic	Within ten (10) calendar days
Follow-up, routine care	Within thirty (30) calendar days
Specialty Care Providers
Non-urgent routine office visit – symptomatic	Within ten (10) calendar days of request
Urgent office visit – symptomatic	Within twenty-four (24) hours

 

After-Hours (PCP, OBGYN, Midwife, Specialist, Behavioral Health):

• After-hours requirements:

1. 1. Must have an answering machine or on-call service
   2. Must have an on-call provider available

• After-hours messaging requirements (live answering service or answering machine):

1. 1. “If this is an emergency, hang up and dial 911”
   2. How to contact an on-call provider messaging examples –
      • “This is how to contact our on-call provider, dial …….”
      • “I will connect you to our on-call provider now”
      • “I will have our on-call provider contact you within 30-minutes”
      • “Please contact the nurse line at……”
   3. Behavioral Health Providers – after-hours messaging should also include a crisis center phone number.

Phone answering timeline standard (during and after business hours):

• Calls being made to your office must be answered within 10 seconds.

CHPW Provider Resources:

• To access CHPW’s Provider Appointment Access and After-Hours Training Program, go to:Provider Center – Training and Resources

If you have any questions or if you are interested in CHPW hosting a training session for your group, please email us at [email protected].