Access to Care Standards

Providers are required to conform to the Access to Care appointment standards to ensure that healthcare services are provided in a timely manner. Primary Care Providers (PCPs) or their designees must be available to members 24 hours a day, seven days a week.

All providers who oversee the member’s health care are responsible for providing the following appointments to Molina Healthcare of California (MHC) members in the timeframes noted:

  • PCP Appointments

    PCP Appointment Types

    Standard

    Emergency Care

    Immediately

    Urgent Care without prior authorization

    Within48 hours of the request.

    Urgent Care with prior authorization

    Within96 hours of the request.

    PCP Routine or Non-Urgent Care Appointments

    Within10 business days of the request.

    PCP Adult Preventive Care

    Within20 business days of the request.

     

 

Timely access standards are based on regulatory and accreditation standards. MHC monitors compliance with these standards and will implement corrective actions for access to healthcare services that do not meet the performance standards.

If you are unable to obtain a timely referral to an appropriate provider, please contact the DMHC Provider Complaint line toll-free at (877) 525-1295 or through their website.

For further instructions, please refer to the Access to Care section under:

For additional information on appointment access standards, contact your local Molina Quality functional area at (888) 562-5442.