The following access to service and waiting time standards shall be met by all carriers filing ACA-compliant health benefit plans in order to comply with network adequacy requirements:
Service Type | Time Frame | Time Frame Goal |
Emergency Care - Medical, Behavioral, Substance Use | 24 hours a day, 7 days a week | Met 100% of the time |
Urgent Care - Medical, Behavioral, Mental Health and Substance Use | Within 24 hours | Met 100% of the time |
Primary Care - Routine, non-urgent symptoms | Within 7 calendar days | Met [GREATER THAN EQUAL TO] 90% of the time |
Behavioral Health, Mental Health and Substance Use Disorder Care, initial and follow-up appointments - Routine, nonurgent, non-emergency | Within 7 calendar days | Met [GREATER THAN EQUAL TO] 90% of the time |
Prenatal Care | Within 7 calendar days | Met [GREATER THAN EQUAL TO] 90% of the time |
Primary Care Access to after-hours care | Office number answered 24 hours/ 7 days a week by answering service or instructions on how to reach a physician | Met [GREATER THAN EQUAL TO] 90% of the time |
Preventive visit/well visits | Within 30 calendar days | Met [GREATER THAN EQUAL TO] 90% of the time |
Specialty Care - non urgent | Within 60 calendar days | Met [GREATER THAN EQUAL TO] 90% of the time |
3 CCR 702-4-2-53-6