23-1463m Keep with Behavior Access Standards Performance Targets to Align with Plan Goals
Date: 12/21/23
These Behavioral Health Appointment Standards align with DMHC All Plan Letter 23-018 on August 17, 2023
Health Net’s, on behalf of CalViva Health, behavioral health appointment access standards align with the requirement set forth by the Department of Management Health Care (DMHC), including updates released in the DMHC All Plan Letter (APL) 23-018 on August 17, 2023.
Physicians and other providers can refer to our performance targets described below for certain standards. Also included is a summary of the behavioral health access standards that we measure and hold physicians and providers to.
NPMH Follow-Up Appointment Performance Targets
Beginning in reporting year (RY) 2024 (measurement year (MY) 2023), the Plan must meet or exceed an 80% Provider Appointment Availability Survey (PAAS) initial performance target for non-physician mental health (NPMH) and substance use disorder providers follow-up appointments.
Beginning in MY 2023, a wait time standard compliance rate of 70% must be met for initial urgent and non-urgent appointments. A member can obtain an appointment with any clinically appropriate in-network provider when scheduling an initial urgent or non-urgent appointment.
The compliance targets above may be adjusted by the DMHC in subsequent reporting and measurement years, as necessary.
Behavioral health access standards
Access measure | Standard | Performance goal |
|---|---|---|
Urgent care1 | Within 48 hours | 90% or more of members with a clinical risk rating of urgent have access to urgent appointments within 48 hours |
Non-life-threatening emergency (NLTE)1 | Within 6 hours | 90% or more of members with a clinical risk rating of NLTE have access to an appointment within 6 hours |
Access to care for life-threatening emergency1 | Immediately | 100% compliance with immediate referral to care |
Rescheduled Appointments2 | Appointment was scheduled to member's satisfaction | 85% or more of members report their appointment was rescheduled to their satisfaction |
Non-urgent appointments with behavioral health care physician (psychiatrist) for routine care3 | Appointment within 15 business days of request | 70% |
Non-urgent appointment with non-physician behavioral health care provider for routine care3 | Appointment within 10 business days of request | 70% |
Urgent care appointment with non-physician behavioral health care provider or behavioral health care physician (psychiatrist) that does not require prior authorization3 | Appointment within 48 hours of request | 70% |
Urgent care appointment with non-physician behavioral health care provider or behavioral health care physician (psychiatrist) that requires prior authorization3 | Appointment within 96 hours of request | 70% |
Non-urgent follow-up appointment with non-physician behavioral health care provider3, 4 | Within 10 business days of request | 80% |
1 Assessed through care management software.
2 Assessed through annual behavioral health member experience survey (ECHO).
3 Assessed through annual Provider Appointment Availability Survey (PAAS).
4 This is measured for commercial (HMO, POS, EPO, PPO) and Medi-Cal plans.
Additional information
For more information about NPMH performance targets for health plans, you can access DMHC APL 23-018 at All Plan Letters.
Relevant sections of the provider operations manuals will be revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on the provider portal > Provider Library under Quick Links, or go directly provider library.
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.