DMHC/DHCS Timely Access Standards + Wait Times Set/Monitored by HPSJ
| Date: | August 26, 2020 |
| To: | HPSJ Quality Management Department |
| From: | HPSJ Quality Management Department |
| Subject: | DMHC/DHCS Timely Access Standards + Wait Times Set/Monitored by HPSJ |
| Business: | Medi-Cal |
Health Plan of San Joaquin (HPSJ) is charged with maintaining the quality of care for our members. As such 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 by and monitored by the Managed Care Plans (MCPs) like HPSJ.
Please review and post the table below as a reminder for your practice scheduling staff and/or include the table in your clinic workflow. Also, please take note of in-office wait times for scheduled appointments.
| AppointmentAccess Standards for Medical Services | |
| Types of Services | Standard |
| Access to non-urgent appointments or primary care – regular and routine care (with a PCP) | Within 10 business days of request |
| Access to non-urgent appointments for mental health (nonphysician1) | Within 10 business days of request |
| Access to urgent care services that do not require prior authorization | Wait time not to exceed 48 hours of request |
| Access to urgent care (specialist and other) services that require priorauthorization | Wait time not to exceed 96 hours of request |
| Access to non-urgent appointments with a specialist | Within 15 business days of request |
| Access to after-hours care (with a PCP) | Ability to contact on-call physician after hours within 30 minutes for urgent issues |
| In-office wait time for scheduled appointments (PCP) | Not to exceed 45 minutes |
| In-office waittime for scheduled appointments (specialist) | Not to exceed 60 minutes |
| Access to preventive health services | Within 30 business days of request |
| Non-urgent appointments for ancillary services for the diagnosis or treatment of injury, illness or other health condition | Within 15 business days of request |
In these tough times during the pandemic:
- If providers are only able to offer limited services due to physical distancing, they always have an option to offer Telehealth services to our members.
- Please contact our Customer Service Department with questions 209.942.6320.
1 PerDMHC, non-physician mental health providers include counseling professionals, substance abuse professionals, and qualified autism service providers
(https://www.dmhc.ca.gov/Portals/0/Docs/DO/TAC_accessible.pdf).