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Appointment Accessibility Standards And 24-Hour Access To Care

Date: 08/14/19

One of the many ways Louisiana Department of Health (LDH) and Louisiana Healthcare Connections work together to provide better care for our members, your patients, is by maintaining requirements for access to care. Primary Care Providers (PCPs) are required to provide acceptable after-hours coverage. All providers are required to maintain appropriate appointment accessibility to services, 365 days per year.  

Providers are required to follow the appointment accessibility standards set by applicable regulatory and accrediting agencies.

Examples of acceptable appointment accessibility standards include:

  • Members seeking routine, non-urgent, preventative care should be scheduled within six weeks.
  • Members seeking non-urgent sick care should be seen within 72 hours.
  • Members seeing urgent care must be seen within 24 hours.
  • Members wait times should not exceed 45 minutes.

Providing after-hours availability and appointment access helps to reduce members' need to seek non-urgent emergency room (ER) utilization. 

Examples of acceptable PCP after-hours coverage include:

  • Provider office phone calls are answered after normal business hours by an answering service. Return calls to members must be made within 30 minutes by a clinical professional.
  • Provider office telephone is answered after normal business hours by a recording directing the member to call another number to reach an available clinical professional.
  • Provider office telephone is transferred after normal business hours to another location where someone will answer the telephone and be able to contact the provider or clinical professional on call within 30 minutes.

Louisiana Healthcare Connections works with regulatory agencies to monitor access to care and to ensure adherence. If a provider fails to meet the established standards, education will be provided and a follow up reassessment will be completed the following quarter.  If after reassessment there is no improvement, the provider will be assigned a corrective action plan.

Complete information on appointment accessibility standards can be found in the Louisiana Healthcare Connections Provider Appointment Standards (PDF). Information about 24-hour access requirements can be found in the Louisiana Healthcare Connections Provider Manual (PDF).