Provider Access and Availability Requirements

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

MedStar Family Choice providers must offer hours of operation to MedStar Family Choice members that are no less in number or scope than the hours of operation offered to commercial or other Medicaid patients. The following appointment guidelines must be followed:

  • Well-child assessments, routine and preventative primary care appointments: 30 days from request
  • Routine office follow-up appointments: 30 days from request
  • High Risk Newborn visits: Within 48 hours of discharge from the birthing center or birthing hospital
  • Lab, X-ray: 30 days from request
  • Urgent care requests: 24 hours from request
  • Initial assessment of pregnant and postpartum women and those requesting family planning services: 10 days from request

Providers must maintain:

  • 24 hour phone coverage
  • Same-day, non-life threatening emergency appointments
  • High risk newborn appointments within 48 hours of discharge
  • Well-Child assessment within 30 days of request
  • Initial EPSDT screens within 60 days of enrollment date
  • IDEA multidisciplinary assessments for at risk infants and toddlers within 30 days of request

In addition, it is important that members know how to reach their providers after hours when they have urgent issues. Provider contracts with MedStar Family Choice require all providers to have mechanisms in place for after-hours coverage. Examples of this type of coverage include cell phone numbers, answering services, or pager numbers.

Information current as of: 10/13/17