CMCS Connections

C M C S c o n n e c t i o n s s p e c i a l i n s e r t • 4 t h q u a r t e r 2 0 1 5 Access to Medical Care Requirements The following time frames for member access to care have been established by the Family and Social Services Administration (FSSA), Office of Medicaid Policy & Planning (OMPP) for: Hoosier Healthwise (Medicaid), Healthy Indiana Plan (HIP) and Hoosier Care Connect (HCC) members (formerly Care Select). APPOINTMENT CATEGORY APPOINTMENT STANDARDS Urgent/Emergent Care Triage 24 hours/day Initial Appointment Well Child Within 1 month of date calling to schedule an appointment Routine Physical Exam 3 months Initial Appointment (Non-pregnant Adult) 3 months Routine Gynecological Examination 3 months New Obstetrical Patient Within 1 month of date attempting to schedule an appointment Non-Urgent Symptomatic 72 hours Children with Special Health Care Needs 1 month SPECIALIST ACCESS STANDARDS HHW, HIP and Hoosier Care Connect also requires the following standards to be maintained regarding patient accessibility for specialist referrals: APPOINTMENT CATEGORY APPOINTMENT STANDARDS Emergency 24 hours Urgent 48 hours Non-Urgent Symptomatic 4 weeks NCQA GUIDELINES • An appointment for regular or routine care within 30 days. • An appointment for urgent care within 48 hours. • An appointment for after-hours care within 6 hours. OMPP REQUIREMENTS FOR PHYSICIAN RESPONSE TIME • For emergencies and urgent situations, MDwise members must be able to reach their Primary Medical Provider (PMP) or designee by telephone within 30 minutes, 24 hours per day, 7 days per week. • For non-urgent routine telephone messages, a return call should be made to the member within one working day.

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