Molina maintains access to care standards and processes for
ongoing monitoring of access to health care (including behavioral health care)
provided by contracted primary PCPs (adult and pediatric) and participating
specialist (to include OB/Gyn, behavioral health Providers, and high volume and
high impact specialists). Providers are required to conform to the Access to
Care appointment standards listed below to ensure that health care services are
provided in a timely manner. The standards are based on 100% availability for
Emergency Services and 75% or greater
for all other services. The PCP or his/her designee must be available 24 hours
a day, 7 days a week to Members.
Appointment Access
All Providers who oversee the Member’s health care are
responsible for providing the following appointments to Molina Members in the
timeframes noted:
Medical Appointment Types |
Standard |
| Routine, asymptomatic |
Within 28 calendar days |
| Routine, symptomatic |
Within 2-3 calendar days |
| Urgent Care |
Within 24 hours |
| After Hours Care |
24 hours/day; 7 day/week availability |
| Specialty Care (High Volume) |
Within 28 – 42 calendar days |
| Specialty Care (High Impact) |
Within 28 - 42 calendar days |
| Urgent Specialty Care |
Within 24 hours |
| Obstetrical Care |
Within 21 calendar days in the first trimester, within 14 calendar days in the second trimester and within 7 days thereafter |
Behavioral Health Appointment Types |
Standard |
| Life Threatening Emergency |
Immediately |
| Non-life Threatening Emergency |
Within 6 hours |
| Urgent Care |
Within 24 hours |
| Routine Care |
Within 14 calendar days |
| Follow-up Routine Care |
Within 7 calendar days |
Additional information on appointment access standards is
available from your local Molina
Quality Department toll free at (877) 872-4716.
Office Wait Time
For scheduled appointments, the wait time in offices should
not exceed sixty (60) minutes. All PCPs are required to monitor waiting times
and adhere to this standard.
After Hours
All Providers must have back-up (on call) coverage after
hours or during the Provider’s absence or unavailability. Molina requires
Providers to maintain a twenty-four (24) hour phone service, seven (7) days a
week. This access may be through an answering service or a recorded message
after office hours. For PCPs and OB/GYNs, if a recorded message is used, it
must provide an option to direct the Member to a live person. The service or
recorded message should instruct Members with an Emergency to hang-up and call
911 or go immediately to the nearest emergency room.
Please
visit the Provider Manual for additional information on access and
availability.