Access to Care
Molina maintains access to care standards and processes forongoing monitoring of access to health care (including behavioral health care)provided by contracted primary PCPs (adult and pediatric) and participatingspecialist (to include OB/Gyn, behavioral health Providers, and high volume andhigh impact specialists). Providers are required to conform to the Access toCare appointment standards listed below to ensure that health care services areprovided in a timely manner. The standards are based on 100% availability forEmergency Services and 75% or greaterfor all other services. The PCP or his/her designee must be available 24 hoursa 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:
|
Type of Care Request |
Standard Timeframe |
|
Primary Care Provider (PCP) or Prenatal Care |
|
|
Emergency Care |
Immediately |
|
Urgent Care |
Within 24 hours |
|
After Hours Care |
24 hours/day; 7 day/week availability |
|
Routine Symtomatic Care |
Within 48 to 72 hrs of request |
|
Routine Asymtomatic Care |
Within 28 calendar days |
|
Follow-up discharge |
Within (7) days of discharge |
|
Well Child Care |
Within 4 weeks of request |
|
Specialty Care Provider |
|
|
Urgent Care - High Impact |
Within 24 hours |
|
Routine Care - High Impact |
Within 42 calendar days |
|
Specialist Referral (non-urgent) |
Within 4 to 6 weeks of request |
|
Prenatal - First Trimester |
Within 21 calendar days |
|
Prenatal - Second Trimester |
Within 14 calendar days |
|
Third Trimester |
Within 7 calendar days |
|
Initial Family Planning Visit |
Within 2 weeks of request |
|
Behavioral Health |
|
|
Life Threatening Emergency |
Immediately |
|
Non-life threatening emergency care |
Within 6 hours |
|
Urgent care |
Within 24 hours |
|
Initial Routine care Visit |
Within 10 business days |
|
Follow-up Routine Care Visit |
Within 5 calendar days |
|
Appointment Wait Times |
|
|
Wait Time |
Less than 1 hr |
Additional information on appointment access standards isavailable from your local MolinaQuality Department toll free at (877) 872-4716.
Office Wait Time
For scheduled appointments, the wait time in offices shouldnot exceed sixty (60) minutes. All PCPs are required to monitor waiting timesand adhere to this standard.
After Hours
All Providers must have back-up (on call) coverage afterhours or during the Provider’s absence or unavailability. Molina requiresProviders to maintain a twenty-four (24) hour phone service, seven (7) days aweek. This access may be through an answering service or a recorded messageafter office hours. For PCPs and OB/GYNs, if a recorded message is used, itmust provide an option to direct the Member to a live person. The service orrecorded message should instruct Members with an Emergency to hang-up and call911 or go immediately to the nearest emergency room.
Please visit the Provider Manual for additional information on access and availability.