Provider Access and Availability Requirements

MedStar Family Choice-DC providers must offer hours of operation to enrollees equivalent to the office hours offered to commercial or other Medicaid enrollees. 

The following appointment guidelines must be followed:

  • Maintain 24 hour phone coverage with emergency directions.
  • Urgent care requests: Within 24 hours from request
  • Same-day, non-life threatening emergency appointments
  • Enrollees waiting room time: No more than 30 minutes and emergency cases should be seen immediately
  • Routine/Preventative Care office visits (PCPs): Within 30 days from request
  • Follow-up appointments (Specialists): Within 30 days from request
  • Well-Child assessment: Within 30 days of request
  • Pregnant/Post-partum and family planning (Initial Appointment): Within 10 calendar days of request
  • High Risk Newborn appointments: Within 48 hours of discharge from the birthing center or birthing hospital
  • IDEA multidisciplinary assessments for at risk infants and toddlers within 25 days of request
  • Initial EPSDT screens: Within 60 days of enrollment date
  • EPSDT Screenings (Laboratory tests / X-ray / Immunizations)
    • EPSDT within 30 days if under the age of two
    • EPSDT within 60 days for two years and older
  • Adults (Healthy) initial office visit 
    • Within 45 days of enrollment
    • Within 30 days of request

In addition, it is important that enrollees know how to reach their providers after hours when they have urgent issues. Provider contracts with MedStar Family Choice-DC 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.

 

This program is funded in part by the Government of the District of Columbia Department of Health Care Finance.
Information current as of: 09/25/20