Provider Rights and Responsibilities
Molina Healthcare expects that its contracted providers will respect the privacy of Molina Healthcare members and comply with all applicable laws and regulations regarding the privacy of patient and member PHI.
In applying the standards listed below, participating providers have agreed they will not discriminate against any member on the basis of:
- National origin
- Sexual orientation
- Marital status
- Mental or sensory handicap
- Place of residence
- Socioeconomic status
- Status as a recipient of Medicaid benefits
Additionally, participating providers or contracted medical groups/IPAs may not limit their practices because of a member’s medical (physical or mental) condition or the expectation for the need of frequent or high cost care. If PCPs choose to close their panel to new members, Molina Healthcare must receive (30) days advance notice from the provider.
Access to Care Standards
Molina Healthcare is committed to providing timely access to care for all members in a safe and healthy environment. Molina Healthcare will ensure providers offer hours of operation no less than offered to commercial members. Access standards have been developed to ensure that all health care services are provided in a timely manner. The PCP or designee must be available twenty-four (24) hours a day, seven (7) days a week to Members for emergency services. This access may be by telephone. Appointment and waiting time standards are shown below. Any member assigned to a PCP is considered his or her patient.
|Type of Care||Appointment Wait Time|
|Preventive Care Appointment- Adults||Within (30) days of request|
|Preventive Care Appointment- Children||Within (60) days of request for children |
Within 14 days for newborns
|Routine Primary Care||Within (14) days of request|
|Routine Specialty Care||Within 21 days of request|
|Urgent Care||Within (24) hours|
|Emergency Care||To be received immediately|
|After-Hours Care||Available by phone (24) hours/seven days|
|Office Waiting Time||Should not exceed (30) minutes|
|Pre-Natal Care||Within 14 days 1st and 2nd trimester |
Within 5 days 3rd trimester
Provider/Member Clinical Dialogue
Molina Healthcare does not place limitations on clinical dialogue. Molina Healthcare encourages open communication regarding treatment the practitioner/provider feels is in the best interest of the patient, regardless of whether or not the particular treatment would be covered by Molina Healthcare.
Provider Change Notification Requirements
Providers must notify Molina Healthcare in writing at least 60 days in advance when possible of changes in physician staffing, practice location changes, billing address and tax ID changes. If PCP’s choose to close their panel to new Members, Molina Healthcare must receive 90 days advance notice from the Provider.
Member Information and Marketing
Any written informational and marketing materials directed at Molina Healthcare Members must be developed at the sixth grade reading level and have prior written consent from Molina Healthcare and the appropriate government agencies. Please contact your Provider Services Representative for information and review of proposed materials. Neither Molina Healthcare, nor any contracted Providers or medical groups/IPA may:
- Distribute to its Members informational or marketing materials that contain false or misleading information
- Distribute to its Members marketing materials selectively within the Service Area
- Directly or indirectly conduct door-to-door, telephonic, or other cold-call marketing for Member enrollment
The above list represents a sample of marketing prohibitions. For a complete list, please contact Provider Services at 1-877-665-4622, press 0 and ask for Provider Relations.