Appointment Accessibility Survey Coming Soon

Date: July 11, 2024

Attention: Primary Care and Specialist Providers

Launch timeframe for survey: July 23, 2024

Call to action: Texas Children’s Health Plan (TCHP) will launch our annual Provider Appointment Accessibility Survey later this month.

Background information: In 2015, Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. TCHP would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines. To accomplish this, we have partnered with PressGaney survey company to conduct an appointment accessibility survey during this summer to verify that network providers meet the required standards.

How this impacts providers: TCHP enforces access and other network standards required by the contract and takes appropriate action with providers whose performance is determined by the health plan to be out of compliance. In addition, providers and staff are responsible for understanding the requirements.

*Please note, not all provider offices are surveyed. It is a random sample chosen by PressGaney.

Authorization reminder: Primary Care Providers, a reminder that a referral is not needed to see an

in-network specialist.

Appointment availability standards

*PROVIDER TYPE*	*LEVEL/TYPE OF CARE*	*APPOINTMENT AVAILABILITY STANDARDS*
*OB/GYN*	Emergency services	Immediately
	Urgent condition	Within 24 hours
	Initial appointment for prenatal care	14 days
	Initial prenatal care appointments for high-risk pregnancies or new members in third trimester (≥24 weeks)	Initial appointment must be offered within 5 days, or immediately, if emergency exists
	Appointments for ongoing OB care must be available in accordance to treatment plan as developed by the provider	Must be available in accordance to the treatment plan as developed by the provider

*PRIMARY CARE*	Emergency services	Immediately
*PHYSICIANS*	Urgent condition	Must be provided within 24 hours
	Primary routine care	Within 14 days
	Preventive health services for Members 21 years of age or older	Within 90 calendar days
	Preventive health services for members less than 6 months of age	Offered as soon as possible but no later than 14 days of enrollment for newborns
	Preventive health services for members 6 months through age 20	Must be provided within 60 days
	New members 20 years of age or younger to receive a Texas Health Steps checkup	Within 90 days of enrollment
	CHIP Members should receive preventive care in accordance with American Academy of Pediatrics (AAP)	AAP Periodicity Schedule

*SPECIALTY CARE*	Emergency services	Immediately
	Urgent condition	Must be provided within 24 hours
	Specialty routine care	21 days

*BEHAVIORAL*	Emergency services	Immediately
*HEALTH*	Urgent condition	Within 24 hours
	Care for non-life threatening emergency	Within 6 hours
	Initial visit for routine care	Within 14 days
	Follow-up routine care	Within 90 days
	Initial outpatient behavioral health visit (Does not apply to CHIP Perinate members)	Within 14 days
	Initial outpatient treatment after inpatient discharge	Within seven (7) days from the date of discharge*

*For more information on behavioral health guidelines see the HEDIS^® tool kit, https://www.texaschildrenshealthplan.org/sites/default/files/2023-11/PR-2308-076%20HEDIS%20Toolkit_FUH_FINAL_V4.pdf

Next steps for providers: Providers should share the appointment availability standards with their staff and implement internal procedures for compliance, if needed.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.