Provider Alert! Provider Offices Are Eligible for Incentive with Completion of Appointment Accessibility Survey

Date: May 8, 2023

Attention: Primary Care and Specialist Providers

Launch timeframe: Summer 2023

Call to action: Texas Children’s Health Plan (TCHP) is excited to launch our annual Provider Appointment Accessibility this summer- this time with a new feature. Providers that complete the survey will be entered into a gift card drawing*. Winning practices will be contacted at the conclusion of the survey.

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 SPH Analytics 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 SPH Analytics.

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 provider alert, http://www.thecheckup.org/2021/02/12/provider-alert-attention-behavioral-health-providers-and-inpatient-facilities/.

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 Network Management at: providerrelations@texaschildrens.org.

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