The Holman Group - Provider Manual

Behavioral Health and EAP Access and Availability Standards

The Holman Group has established access standards for face-to-face services as required by the Department of Managed Health Care (DMHC).

A. Providers must be able to offer a member an appointment with five (5) business days for routine cases, 48 hours for Urgent cases, or within 6 hours for non life threatening emergent cases. All other life threatening cases need to be directed to 911 or the nearest Hospital. Providers shall cooperate and comply, as set forth in the Provider Manual.

The access standard can be changed if the referring or treating licensed care provider assesses a different standard is acceptable and within recognized standards of practice. Any deviation from the standard needs to be documented in the member’s record indicating that the longer waiting time will not have an adverse effect on the member’s well-being.

B. It is the provider’s responsibility to be in compliance with the following standards: Disclose hours of operations to clients (new and established), by including this information on a pre-recorded telephone message or any other effective and verifiable means; provide coverage for your practice when not available, including , but not limited to having an answering service with emergency contact information; inform members of how to proceed should they need services after business hours, including but not limited to providing a pre-recorded telephone message with directions for the callers or clients to call 911 or go to nearest emergency room, in case of an emergency; inform members as to when they can expect a return call after leaving a message (and to call an alternate number or 911 if assistance is needed sooner); and respond to telephone messages in a timely manner.

C. Provider shall inform the Enrollees/Members that language assistance services are available and provided to them at no charge by the Plan.

In addition providers are also responsible for the following:

• Providers shall notify the Plan if a situation arises in which language assistance is needed for a Limited English Proficient member.
• Providers shall notify the Plan within one business day of any requests for translation or interpretation of vital documents.
• Provider shall ensure that their office staff members who are in contact with members are trained to work effectively with in-person and telephone interpreters.
• The Providers shall submit an attestation in regards to their availability, either through themselves or an employee, to provide services in a language other than English.
• Provider is required to submit an update any changes that have occurred to its language assistance capabilities by contacting the Provider Relations Department.

D. Office appointment wait times should be less than 30 minutes after the members scheduled appointment with the provider.