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.