Mandatory Appointment Availability Standard

Health Plan of San Joaquin (HPSJ) is charged with maintaining the quality of care for our members. We must monitor access and availability within the network, making sure access standards are observed by contracted providers and any deficiencies are addressed. These access standards are set forth by both the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC), with the exception of in-office wait times—those in-office wait times are set and monitored by HPSJ.

After-Hours Access Survey & Questions

Medi-Cal health plans are required to conduct a yearly After-Hours Access Survey with a sampling of our contracted provider offices. It is designed to help determine the level of access our Medi-Cal members have for urgent/emergent after-hours care throughout the network by testing the messaging content that provider offices use via answering service or through voicemail/messaging equipment and software.

Here is an overview:

  • To pass the survey, all (4) questions listed in the After-Hours Access table needed to be answered with a “Y”.
  • Those provider offices that received at least one “N,” received a “non-passing” score and are required to adjust their messaging process and messaging content to be fully compliant.
  • Notification letters are sent out informing the provider office of any questions areas that may have failed the survey.
  • Sites that are identified with non-passing scores will be resurveyed to verify that their after-hours messaging meets all Medi-Cal compliance points.

The next survey period is scheduled in November, annually. Please be sure that your messaging has been updated to follow the requirements.

Appointment Access Standards for Medi-Cal

Members have the right to be scheduled for appointments within the following time frames :

Per DMHC, non-physician mental health providers include counseling professionals, substance abuse professionals, and qualified autism service providers. Access the Timely Access to Care Fact Sheet by visiting the following URL: https://dmhc.ca.gov/Portals/0/Docs/DO/TAC_accessible.pdf

If you have questions, contact our Provider Services Department at 209.942.6340.

Posted on November 15th, 2021 and last modified on November 16th, 2021.

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