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Appointment Availability and Wait Times

Sunflower follows the accessibility and appointment wait time requirements set forth by KanCare and applicable regulatory and accrediting agencies. Sunflower monitors participating provider compliance with these standards at least annually and will use the results of appointment standards monitoring to ensure adequate appointment availability and access to care and to reduce inappropriate emergency room utilization. The tables below depict the appointment availability and wait time standards for Sunflower members:

PRIMARY CARE PROVIDERS

TYPE OF PROVIDER

APPOINTMENT STANDARDS

Regular Appointments

Not to exceed 3 weeks from date of member request

Urgent Care

48 hours

SUBSTANCE USE DISORDER (SUD) PROVIDERS

TYPE OF PROVIDER

APPOINTMENT STANDARDS

Emergent

On-demand service. No prior authorization is required, and members go directly to an emergency room. Members are seen immediately.

Urgent

Assessment conducted within 24 hours of the initial contact, and services delivered within 48 hours of initial contact.

IV Drug Users

Within 14 days of initial contact.

Routine

Members are assessed within 14 days of initial contact, and treatment services delivered within 14 days of assessment.

MENTAL HEALTH ACCESS STANDARDS

TYPE OF PROVIDER

APPOINTMENT STANDARDS

Post-Stabilization Services

Referral within 1 hour. Assessment and/or treatment within 1 hour of referral for post-stabilization services (both inpatient and outpatient) in an emergency room.

Emergent

Referral immediately. Assessment and/or treatment within 3 hours for an outpatient mental health service, and within 1 hour from referral for an emergent concurrent utilization review screen.

Urgent

Referral within 24 hours. Assessment and/or treatment within 48 hours from referral for outpatient mental health services, and within 24 hours from referral for an urgent concurrent utilization review screen.

Planned Inpatient Psychiatric

Referral within 48 hours. Assessment and/or treatment within 5 working days from referral.

Routine Outpatient

Referral within 5 days. Assessment and/or treatment within 9 working days from referral; 10 working days from previous treatment.

Pregnant Women

Treatment within 24 hours of an assessment. IV drug users shall be admitted no later than 14 calendar days after an assessment or 120 calendar days after the date of such request. Interim services shall be made available no later than 48 hours after such request.

SPECIALTY AND URGENT CARE (INCLUDES SPECIALTY PHYSICIAN SERVICES, HOSPICE CARE, HOME HEALTHCARE, SUD TREATMENT, REHABILITATION SERVICES, ETC.)

TYPE OF PROVIDER APPOINTMENT STANDARDS

Routine Care

Not to exceed 30 days.

Urgent Care

Not to exceed 48 hours.

EMERGENCY CARE

TYPE OF PROVIDER APPOINTMENT STANDARDS

Emergency Care

Immediate, at the nearest facility available, regardless of participation status with Sunflower.

HOSPITALS

TYPE OF PROVIDER APPOINTMENT STANDARDS

Hospitals

Transport time not to exceed 30 minutes

GENERAL OPTOMETRY SERVICES

TYPE OF PROVIDER APPOINTMENT STANDARDS

Routine Care

Not to exceed 3 weeks for regular appointments

Urgent Care

Not to exceed 48 hours

LAB AND X-RAY SERVICES

TYPE OF PROVIDER APPOINTMENT STANDARDS

Routine Care

Not to exceed 3 weeks for regular appointments

Urgent Care

Not to exceed 48 hours

WAIT TIME STANDARDS FOR ALL PROVIDER TYPES

Office waiting time for scheduled appointments:

Not to exceed 45 minutes. If a provider is delayed, patients shall be notified immediately. If the wait is anticipated to be more than 90 minutes, the patient shall be offered a new appointment.