Access to Care Standards

Providers are required to conform to the Access to Care appointment standards to ensure that healthcare services are provided in a timely manner. Primary Care Providers (PCPs) or their designees must be available to members 24 hours a day, seven days a week.

All providers who oversee the member’s health care are responsible for providing the following appointments to Molina Healthcare of California (MHC) members in the timeframes noted:

  • Behavioral Health Appointment

      Behavioral Health Appointment Types

      Standard

      Urgent Care with a Behavioral Health Provider without prior authorization

      Within ≤ 48 hours of the request.

      Urgent Care requiring prior authorization with a Behavioral Health Provider

      Within ≤ 96 hours of the request.

      Routine or Non-Urgent Care Appointments with a Behavioral Health Provider

      Within ≤ 10 working days of the request.

      Behavioral Health Non-life-threatening emergency

      Within ≤ 6 hours of the request.

      BH – Routine Follow-up with Prescribers (i.e., Psychiatrist)

      Within ≤ 30 business days from the initial appointment for a specific condition

      BH – Routine Follow-up with Non-Prescribers

       

      Within ≤ 10 business days from the initial appointment with non-prescribers (i.e., non-physician mental health care or substance use disorder provider) for a specific condition

      Routine or Non-Urgent Care Appointment with a Non-Physician Mental Health Provider or substance use disorder providers

      Within ≤ 10 working days of the request.

 

Timely access standards are based on regulatory and accreditation standards. MHC monitors compliance with these standards and will implement corrective actions for access to healthcare services that do not meet the performance standards.

If you are unable to obtain a timely referral to an appropriate provider, please contact the DMHC Provider Complaint line toll-free at (877) 525-1295 or through their website.

For further instructions, please refer to the Access to Care section under:

For additional information on appointment access standards, contact your local Molina Quality functional area at (888) 562-5442.