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8.6.13.2.4 Access and Availability Standards
PCCM staff routinely evaluates and monitors provider compliance with scheduling requirements. These scheduling requirements are designed to enhance access to health services and to provide assurance of service availability based on the urgency of need:
• THSteps. Preventative health services, including well-child checkups, should be offered to clients birth through 20 years of age in accordance with the THSteps Program periodicity schedule. Newly enrolled members who are birth through 20 years of age, should be offered overdue or upcoming well-child checkups, including THSteps medical checkups as soon as practicable, but no later than 14 days of enrollment for newborns, and no later than 60 days of enrollment for all other eligible child members.
•Emergency Services. Provided upon member presentation at the time the service delivery site, including at non-network and area facilities.
•Urgent care. Within 24 hours after the request.
•Routine care. Within two weeks after the request.
•Initial outpatient behavioral health visits. Provided within 14 days of request.
•Physical/wellness exams. Within four to eight weeks after the request.
•Prenatal care. Initial visit within 14 calendar days of the request or by the 12th week of gestation except for high-risk pregnancies or new members in the third trimester for whom an appointment must be offered within five (5) days, or immediately, if an emergency exists.
Refer to: Subsection 8.1.10, "Primary Care Provider Requirements and Information" in this section.
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