Date: February 27, 2026
Attention: All Providers
Call to action: To ensure Texas Children’s Health Plan (TCHP) members, your patients, receive timely access to care, primary care physicians (PCPs), specialty providers, OB/GYNs, and behavioral health providers must maintain the following 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 | Within 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 |
| PCPs | Emergency services | Immediately |
| | Urgent condition | Within 24 hours |
| | Primary routine care | Within 14 days |
| | Preventive health services for members 21 years of age or older | Within 90 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 | 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) | Follows American Academy of Pediatrics (AAP) Periodicity Schedule |
| SPECIALTY CARE | Emergency services | Immediately |
| | Urgent condition | Within 24 hours |
| | Specialty routine care | Within 21 days |
| BEHAVIORAL | Emergency services | Immediately |
| HEALTH | Urgent condition | Within 24 hours |
| | Care for non-life threatening emergency | Within 6 hours (NCQA) |
| | 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 7 days from the date of discharge |
Appointment Availability Requirements
TCHP is committed to ensuring members have timely access to care. Because quality access depends on the availability of our network providers, we review the regulatory and accreditation standards set by the Texas Health and Human Services Commission (HHSC) and the National Committee for Quality Assurance (NCQA) on an ongoing basis.
Authorizations
PCPs: A referral is not required for members to see an in-network TCHP specialist.
After Hours Access
TCHP network PCPs must be accessible to members 24 hours a day, seven days a week. It is important to keep TCHP updated with changes to your on-call providers. Providers must maintain after hours access in compliance with TCHP and state requirements to ensure members can reach a clinician for urgent medical needs outside of regular office hours. Providers must comply with the following after hours telephone availability standards:
- Office phone is answered during normal business hours.
- After business hours, provider must have one of the following arrangements:
- Office telephone is answered after hours by an answering service that meets the language requirement of the major population groups and that can contact the PCP or another designated medical practitioner. All calls answered by an answering service must be returned within 30 minutes.
- Office telephone is answered after normal business hours by a recording in the language of each major population group served, directing the patient to call another number to reach the PCP or another provider designated by the PCP. Someone must be available to answer the designated provider’s telephone. Another recording is not acceptable.
- Office telephone is transferred after office hours to another location where someone will answer the telephone and be able to contact the PCP or another designated medical provider, who can return the call within 30 minutes.
For more information on TCHP’s after hours resources, including the 24-Hour Nurse Help Line and Texas Children’s Anywhere Care, and in-network urgent care facilities visit: https://www.texaschildrenshealthplan.org/skip-the-wait
Next Steps for Providers
Providers should:
- Review these appointment availability standards with all clinic and scheduling staff.
- Implement internal processes as needed to ensure compliance with required timelines.
- Monitor performance to maintain adherence to TCHP and state standards.
Resources
Thank you for your continued dedication to providing exceptional care to our members, your patients.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into: www.texaschildrenshealthplan.org/provideralerts.
