Access to Care Standards

Posted on December 5th, 2025 in Bulletin Board by chpadmin

Access standards were developed to ensure that health care services are provided in a timely manner. CHPW is committed to following appointment and after-hours standards/requirements as set forth by the Health Care Authority (HCA) and other regulatory and accreditation agencies. CHPW members should be offered the same hours of operations as commercially insured patients. The following information outlines access standards and responsibilities:

Type of Appointment	Scheduling Time Frame
All Providers
Emergency Care	Immediately, and available 24/7
Transitional visit (clinical assessment or care planning)	Within seven (7) calendar days of member’s discharge from an inpatient or behavioral health facility or substance use disorder treatment program.
Second Opinion	Within thirty (30) calendar days of the request unless the Enrollee requests a postponement of the second opinion to a date later than thirty (30) calendar days.
PCP, OB/GYN, Midwife
Routine/preventative office visit	Within thirty (30) business days
Non-urgent office visit	Within seven (7) business days
Urgent, symptomatic office visit	Within twenty-four (24) hours
Behavioral Health Providers
Care for a non-life-threatening emergency	Within six (6) hours
Urgent care	Within twenty-four (24) hours – *CS – Next Day
Initial visit, routine care	Within seven (7) business days
Follow-up, routine care	Within thirty (30) business days
Specialty Care Providers
Specialty Care	Within thirty (30) business days

*Cascade Select

Other Requirements

• Maintain an appointment system for members for prompt access to health care
• Maintain continuity of care.
• Inform members of their right to self-refer for certain services.
• Provide or arrange for interpretive services for members who are hearing impaired or whose primary language is not English.
• Obtain informed consent from the member, or from a person authorized to consent on behalf of the member, prior to treatment.
• Provide adult members with written information about advance directives and the

right to make anatomical gifts.

Specialists:

Specialists must provide the members with a written report within 14 days of the date of service regarding the proposed plan of treatment, including any proposed hospitalization or surgery and information regarding self-referred services such as women’s health care services.

Access to Providers 24 Hours a Day, Seven Days a Week (24/7)

CHPW providers are required to maintain access to health care services on an ongoing basis and shall ensure that services are accessible to members as needed 24/7, 365 days/year –

• Provider offices must answer the phone during and after normal business
• Calls being made to your office must be answered within 10 seconds.

After-Hours (PCP, OBGYN, Midwife, Specialist, Behavioral Health): 

• After-hours requirements (after normal business hours, weekends and/or holidays):

1. 1. After-hours coverage must be accessible using the medical office’s daytime phone number.

1. 2. Must have an answering machine or on-call service

• • • Recorded message must be provided in English – for practices/clinics with a high population of Spanish-speaking members, the message should also be recorded in Spanish.

1. 3. Must have an on-call provider available:

• • • After-hour coverage requires providers to connect the patient to someone who can provide a clinical decision or reach a PCP/Specialist for a clinical decision.
    • The PCP, Specialists, or on-call medical professional must respond to the initial contact within thirty (30) minutes.
• After-hours messaging requirements (live answering service or answering machine):

1. 1. “If this is an emergency, hang up and dial 911”

• • • Behavioral Health Providers – after-hours messaging should also include a crisis center phone number and the 988 Suicide Crisis Lifeline .

1. 2. How to contact an on-call provider messaging (examples):

• • • “To contact an on-call provider, dial …….”
    • “Press 1 and you will be connected to our on-call provider now”
    • “Follow the prompts and our on-call provider will contact you within 30-minutes”
    • “Please contact the nurse line at……”

CHPW Provider Access Training & Resources:

For more information and to access CHPW training programs, go to: CHPW Provider Training Programs, www.chpw.org and/or refer to your contractual agreement. For questions, please contact your Provider Relations Representative or email [email protected].