December 2016

Access and Availability Standards: Are You There?

Last month, we emphasized the importance of health literacy through breaking language barriers. Just as important though are members’ ability to access care. Appointment availability and after-hours access are an aspect of patient care that providers, nursing staff and front office staff need to be aware of. Patients must be seen within a certain amount of time based on the type of appointment they need. The state-mandated timeframes are listed below.

Access and Availability Standards:

• Emergent – Immediate
• Urgent – Within 24 hours
• Routine Care – 14 days
• Preventive Care – 90 days

Primary Care Physicians (PCPs), Obstetricians and Gynecologists (OB/GYNs) must be available to their patients 24/7. In addition, when a member calls their physician’s office after hours, the call must be answered or recorded in English and Spanish, or have an interpreter available. The answering service must also be able to page the physician, or a number must be provided to reach the provider on call; the physician must return the call within 30 minutes.

The ability for patients to access care during and after hours is an important framework for many facets of health care. This impacts many other aspects of our health care system including, but not limited to, potentially preventable events (PPEs), HEDIS^® measures, adequate follow-up care, and ultimately, the health and wellness of our shared members.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).