19-372 Call to Action - DHCS Study on Appointment Availability
Date: 05/15/19
Ensure members have timely access to health care services
The California Department of Health Care Services (DHCS) has contracted with Health Services Advisory Group, Inc. (HSAG) to conduct a study to assess the extent which Medi-Cal managed care health plan (MCP) network providers are meeting appointment wait time standards.
California Health & Wellness Plan (CHWP) network providers are required to ensure members are receiving timely appointments per state requirements (see table on page 2 for the subset of the standards being surveyed). If you offer walk-in or same-day appointments, please be sure to indicate this on the call with the surveyor.
Providers will be surveyed on the below:
- Ability to offer members appointments according to the timely access standards as listed in the table on page 2.
- Participation with California Health & Wellness Plan (CHWP).
- It is important that you give the correct participation response of “yes” when the surveyor is asking if you accept CHWP Medi-Cal.
- If there are changes to your participation or panel status, notify your provider relations representative at any time.
- Panel status, such as accepting or not accepting new patients.
DataStat, HSAG’s vendor, will contact providers based on the schedule and provider specialties listed below:
| 2019 Call date range | Provider specialties |
Phase 1 | February 15–March 29 | PCPs, OB/GYNs, cardiologists/interventional cardiologists, and psychiatrists |
Phase 2 | May 17–June 28 | PCPs, OB/GYNs, endocrinologists, and gastroenterologists |
Phase 3 | August 19–September 30 | PCPs, OB/GYNs, dermatologists, neurologists, and pulmonologists |
Phase 4 | November 13–December 31 | PCPs, OB/GYNs, general surgeons, hematologists, HIV/AIDS specialists/infectious disease specialists, nephrologists, oncologists, ophthalmologists, orthopedic surgeons, otolaryngologists/ENT specialists, and physical medicine/rehabilitation specialists |
APPOINTMENT AVAILABILITY STANDARDS
Appointment type | Appointment standard |
Primary care physicians (PCPs) and specialists | |
Urgent care appointments with PCPs | Appointment within 48 hours of request |
Urgent care appointments with specialists that do not require prior authorization | Appointment within 48 hours of request |
Urgent care services (specialist) that require prior authorization | Appointment within 96 hours of request |
Non-urgent appointments with PCP | Appointment within 10 business days of request |
Non-urgent appointments with specialist | Appointment within 15 business days of request |
Ancillary services | |
Access to non-urgent ancillary services for magnetic resonance imaging (MRI), mammogram, physical therapy | Appointment within 15 business days of request |
Behavioral health services | |
Access to non-urgent appointment with physician (psychiatrist) for routine care | Appointment within 15 business days of request |
Access to non-urgent appointment with non-physician behavioral health care provider | Appointment within 10 business days of request |
Access to urgent care (psychiatrist) | Appointment within 48 hours of request |
Access to urgent care (non-physician) | Appointment within 48 hours of request |
ADDITIONAL INFORMATION
Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.