Target Date Access Standards Provider Directories / Expedited Credentialing HHSC Provider Studies Appointment Assistance September 2016 Analysis and review of stakeholder Implement contract changes requiring Effective date of contract changes Finalize planning and initiate second feedback related to revised access MCOs to include a provider directory requiring MCO to conduct year (2016) appointment availability standards completed search tool on their websites. expedited credentialing for new studies The Appointment Availability Propose March 2017 contract changes Develop MCO "critical elements" for provider types, including: Study uses "secret shoppers" to that that update access standards for online provider directories. This includes Licensed Clinical Social directly monitor MCO provider Managed Care Organizations (MCOs). the mandatory online directory functions Workers networks and determine member Proposed standards include the following: and content based on stakeholder Dentists experience with accessing and Updated county designations feedback and other resources. This Dental Specialists, and scheduling appointments with MCO chapter ensures members have access to providers. based on Medicare Advantage Nursing Facilities that similar functionality across MCOs standards, including Rural, Metro undergo change in Propose March 2017 contract changes and Micro ownership that require MCOs to provide three-way Expanded and more granular Finalize review of stakeholder calling between a member or authorized provider types assessed for feedback related to additional representative, member services hotline network adequacy provider types eligible for staff, and provider's office to ensure that Inclusion of travel time standards expedited credentialing appointments are made in a timely in addition to traditional mileage Propose March 2017 contract fashion. Members will have the choice to standards changes requiring MCO to conduct either participate in three-way calling or Revised process of conducting expedited credentialing for new receive a list of providers in their area internal Health and Human provider types, including: Propose March 2017 contract changes Services Commission (HHSC) Licensed Professional that require MCOs to have an e-mail analysis rather than relying on Counselors address where members can request MCO self-reported data Psychologists, and appointment assistance. Members may Continue beta-testing of software to Licensed Marriage and either receive feedback via e-mail or get assess travel time requirements Family Therapists a call back from member services hotline staff
Target Date Access Standards Provider Directories / Appointment Assistance Expedited Credentialing HHSC Provider Studies September 2016 Analysis and review of stakeholder feedback related to revised access standards completed Propose March 2017 contract changes that that update access standards for Managed Care Organizations (MCOs). Proposed standards include the following: Updated county designations based on Medicare Advantage standards, including Rural, Metro and Micro Expanded and more granular provider types assessed for network adequacy Inclusion of travel time standards in addition to traditional mileage standards Revised process of conducting internal Health and Human Services Commission (HHSC) analysis rather than relying on MCO self-reported data Continue beta-testing of software to assess travel time requirements Implement contract changes requiring MCOs to include a provider directory search tool on their websites. Develop MCO "critical elements" for online provider directories. This includes the mandatory online directory functions and content based on stakeholder feedback and other resources. This chapter ensures members have access to similar functionality across MCOs Propose March 2017 contract changes that require MCOs to provide three-way calling between a member or authorized representative, member services hotline staff, and provider's office to ensure that appointments are made in a timely fashion. Members will have the choice to either participate in three-way calling or receive a list of providers in their area Propose March 2017 contract changes that require MCOs to have an e-mail address where members can request appointment assistance. Members may either receive feedback via e-mail or get a call back from member services hotline staff Effective date of contract changes requiring MCO to conduct expedited credentialing for new provider types, including: Licensed Clinical Social Workers Dentists Dental Specialists, and Nursing Facilities that undergo change in ownership Finalize review of stakeholder feedback related to additional provider types eligible for expedited credentialing Propose March 2017 contract changes requiring MCO to conduct expedited credentialing for new provider types, including: Licensed Professional Counselors Psychologists, and Licensed Marriage and Family Therapists Finalize planning and initiate second year (2016) appointment availability studies The Appointment Availability Study uses "secret shoppers" to directly monitor MCO provider networks and determine member experience with accessing and scheduling appointments with MCO providers.