Access to Care
Molina maintains access to care standards and processes forongoing monitoring of access to health care (including behavioral health care)provided by contracted primary PCPs (adult and pediatric) and participatingspecialist (to include OB/Gyn, behavioral health Providers, and high volume andhigh impact specialists). Providers are required to conform to the Access toCare appointment standards listed below to ensure that health care services areprovided in a timely manner. The standards are based on 100% availability forEmergency Services and 75% or greaterfor all other services. The PCP or his/her designee must be available 24 hoursa day, 7 days a week to Members.
Appointment Access
All Providers who oversee the Member’s health care areresponsible for providing the following appointments to Molina Members in thetimeframes noted:
Medical Appointment Types | Standard |
| Routine, asymptomatic | Within 28 calendar days |
| Routine, symptomatic | Within 2-3 calendar days |
| Urgent Care | Within 24 hours |
| After Hours Care | 24 hours/day; 7 day/week availability |
| Specialty Care (High Volume) | Within 28 – 42 calendar days |
| Specialty Care (High Impact) | Within 28 - 42 calendar days |
| Urgent Specialty Care | Within 24 hours |
| Obstetrical Care | Within 21 calendar days in the first trimester, within 14 calendar days in the second trimester and within 7 days thereafter |
Behavioral Health Appointment Types | Standard |
| Life Threatening Emergency | Immediately |
| Non-life Threatening Emergency | Within 6 hours |
| Urgent Care | Within 24 hours |
| Routine Care | Within 14 calendar days |
| Follow-up Routine Care | Within 7 calendar days |
Additional information on appointment access standards isavailable from your local MolinaQuality Department toll free at (877) 872-4716.
Office Wait Time
For scheduled appointments, the wait time in offices shouldnot exceed sixty (60) minutes. All PCPs are required to monitor waiting timesand adhere to this standard.
After Hours
All Providers must have back-up (on call) coverage afterhours or during the Provider’s absence or unavailability. Molina requiresProviders to maintain a twenty-four (24) hour phone service, seven (7) days aweek. This access may be through an answering service or a recorded messageafter office hours. For PCPs and OB/GYNs, if a recorded message is used, itmust provide an option to direct the Member to a live person. The service orrecorded message should instruct Members with an Emergency to hang-up and call911 or go immediately to the nearest emergency room.
Please visit the Provider Manual for additional information on access and availability.