Access to Care

Date: 09/13/19

California Health & Wellness Plan (CHWP) follows the appointment wait time standards set by regulators and accrediting agencies. We monitor compliance with these regulatory standards yearly to make sure there is availability and access to providers.

Appointment accessibility standards

Availability is key to member care and treatment outcomes. Primary care physicians (PCPs) and specialty care physicians (SCPs) must meet these wait time standards.

Urgent care appointment	Access standard
Urgent care appointment with PCP	Within 48 hours of request
Urgent care appointment with SCP (prior approval needed)	Within 96 hours of request
Urgent care appointment with non-physician mental health provider	Within 48 hours of request

Non-urgent care appointment	Access standard
Non-urgent care appointment with PCP	Within 10 business days of request
Non-urgent care appointment with SCP	Within 15 business days of request
Non-urgent care appointment with non-physician mental health provider	Within 10 business days of request
Appointment for ancillary services	Within 15 business days of request
First prenatal visit	Within 10 business days of request
Well-child visit	Within 10 business days of request
Wellness check	Within 30 calendar of request

Refer to the provider manual for other regulatory standards.

In-office wait time for scheduled appointments must not exceed 30 minutes.

After-hours requirements

Directing patients to the proper after-hours care can:

• Reduce improper use of emergency room services.
• Improve health outcomes.

After-hours access	Access standard
After-hours physician availability	Within 30 minutes of call
After-hours emergency room (ER) instruction	Appropriate emergency instructions

 

Telephone response	Wait time standard
Telephone answer time	Answer calls within 60 seconds
Telephone call back for non-urgent issues	Call patients back within 1 business day

Be sure to discuss after-hours and weekend access to care during your first visit with each patient and at least yearly.

Providers are required to offer access to a covering physician after business hours. Or providers must have:

• An answering service.
• Triage service or,
• Voice message that explains to members how to access urgent and emergency care.

This helps ensure our members get the best possible health care.

For more information about access to care, go to the provider portal at www.CAHealthWellness.com. Search under Providers > Provider Resources > Manuals, Forms and Resources > Provider Manual > Primary Care Providers (PCP) and Other Providers > Appointment Accessibility Standards.