Member’s access to behavioral health care

As a participating provider please be reminded of your contractual obligation to help ensure our members have prompt access to behavioral health care:

 

• Non-life threatening emergency needs - must be seen, or have appropriate coverage directing the member, within 6 hours. When the severity or nature of presenting symptoms is intolerable but not life threatening to the member.
• Urgent needs - must be seen, or have appropriate coverage directing the member, within 48 hours. Urgent calls concern members whose ability to contract for their own safety, or the safety of others may be time-limited, or in response to a catastrophic life event or indications of active substance use or threat of relapse. Urgent needs have the potential to escalate into an emergency without clinical intervention.
• Routine office visit - must be within 10 business days. Routine calls concern members who present no immediate distress and can wait to schedule an appointment without any adverse outcomes.

 

We use several methods to monitor adherence to these standards. Monitoring is accomplished by:

 

1. assessing the availability of appointments via phone calls by our staff or designated vendor to the provider’s office;
2. analysis of member complaint data; and
3. analysis of member satisfaction.

 

Providers are expected to make best efforts to meet these access standards for all members.