Appointment Availability Standards Reminder for 2025
Date: July 18, 2025
Attention: Primary Care and Obstetric Care Providers
| Call to action: Texas Children’s Health Plan (TCHP) would like to remind providers of the appointment availability standards. Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines. |
| Provider Type | Level/Type of Care | Appointment Accessibility Standards |
| OB/GYN | Low Risk Pregnancies | Provided within 14 calendar days |
| High Risk Pregnancies | Offered within 5 calendar days | |
| New Members in the Third Trimester | Offered within 5 days | |
| Primary Care | Urgent care | Within 24 hours |
| Emergency Care visit | Immediately or refer to ER | |
| Routine primary care | Within 14 days | |
| New child Member (< 20 years old) or adult preventive appointment | Within 90 calendar days | |
How this impacts providers: Texas Children’s Health Plan 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.
Resource:Appointment-availability standards are available by clicking here or visiting https://www.hhs.texas.gov/about/process-improvement/improving-services-texans/medicaid-chip-quality-efficiency-improvement/appointment-availability.
Authorizations
Primary Care Providers, a reminder that a referral is not required to see a TCHP in-network specialist.
Next step for Providers: Providers should share the appointment availability standards with their staff and if needed, implement internal procedures for compliance.
If you have any questions, please email Provider Relations at:providerrelations@texaschildrens.org.
For access to all provider alerts:www.texaschildrenshealthplan.org/provideralerts.