Accessibility Standards for Behavioral Health Care

Priority Health's Behavioral Health Department triages requests from members seeking behavioral health services and assists them in securing appointments with practitioners. Here are the Priority Health standards for member telephone access to providers and appointment scheduling to ensure timely access of care for members.

A.  Telephone Access
The Behavioral Health Department ensures timely access to its members with the following telephone standards:
1.    Callers reach a non-recorded voice in less than 25 seconds
2.    The telephone abandonment rate is less than 4%
Measurement methodology:  The telephone system provides data, by telephone queue, for the average speed of answer and the abandonment rates monthly, quarterly, and year-to-date.


B.    Appointment Scheduling
Three appointment standards are based on the members level of risk.  

1.    Non-life-threatening emergent:
A situation in which a member is suicidal or homicidal but not engaged in the act, or is psychotic (with violent command hallucinations or exhibiting dangerous behavior) and is not in a professional setting where they can be safely monitored.

• Standard:  Appointment available within 4 hours

2.    Urgent: 
A situation in which a member has suicidal ideation but no intent, or members who experience severe psychological distress which may interfere with normal functioning and/or lead to further deterioration of emotional or physical health or is actively in danger to self or other, but is being monitored by a crisis intervention or medical professional who is able to keep the member safe (i.e., PCP’s office, a Behavioral Health practitioner, an emergency room or ambulance).

• Standard:  Appointment availability within 24 hours

3.    Routine: 
A situation in which a member is seeking treatment for situational stress such as family or work related problems, with no suicidal or homicidal ideation or imminent risk of deterioration of emotional or physical health, or when a case manager arranges a transfer of an at-risk member from a medical confinement to a psychiatric or substance abuse treatment facility.

• Standard: Appointment availability in 10 business days.

C. Measurement Methodology
1.    A non-life-threatening emergent appointment

• Standard:  Appointment available within 4 hours – 100%
• Measurement Methodology: The percent of time an appointment is available within 4 hours measured from the time that the member calls to the Behavioral Health Department to the first available/offered appointment time to the member.  Data is entered into and retrieved from the administrative tracking systems for each case.  Measurements are performed monthly and aggregated for year-to-date data.
  

2.    An urgent appointment

• Standard:  Appointment availability within 24 hours – 95%
• Measurement Methodology:  The percent of time an appointment is available within 24 hours measured from the member calls to the Behavioral Health Department to the first available/offered appointment time to the member.  Data is entered into and retrieved from the administrative tracking system for each case.  Measurements are performed monthly and aggregated for year-to-date data.
  

3.    A routine appointment

• Standard: Appointment availability in 10 business days.
• Measurement Methodology: Viewing the scheduling book, or computer for the next available routine appointment time.  Priority Health will review providers who treated 50% or more of the members who received Behavioral Health services for routine accessibility.  These practitioners will include the top 50 high volume providers as well as randomly selected providers in order to achieve an adequate number of practitioners.  Reviews will also include behavioral health office sites at the time of triennial recredentialing, and during prospective high volume behavioral health precredentialing site visits.  The measurement includes all practitioners at the site visited.  The aggregate results are performed annually.
  

24-Hour Access and On-Call Policy for Behavioral Health Providers

All Priority Health contracted Behavioral Health providers are required to have appropriate after-hours coverage.  Providers should be accessible 24 hours per day, 7 days per week, 365 days per year.  The following options are acceptable accessibility techniques:

• An answering service that will contact the provider on behalf of the member.
• An answering machine with explicit directions (including another telephone number if necessary) on how to each a provider and action to take in emergency.  The provider may ask the member to leave a message but must be able to respond in an explicit manner.
• Rural providers* may direct members to the emergency room via an answering machine only if there is no participating provider in the same field of practice to share on-call coverage.  The instructions must clearly direct members with non-emergent situations to call the emergency room first.  The message should also provide the telephone number(s) of the emergency room(s) available in the area.
  
  *  The rural service area includes the following counties:  Barry, Gratiot, Ionia, Mecosta, Montcalm, Newaygo, Oceana and Isabella.
  
  NOTE:  Referral to local Community Mental Health is not acceptable as after-hour coverage, unless the individual providers have contractual arrangements for CMH payment.
  
• In determining compliance, individual circumstances will be taken into account, i.e. certain types of specialty practices.
  

At the time of the re-credentialing site visit, Priority Health will make after-hour phone calls to provider offices.  If an answering machine directs the caller to leave a message, we may request the provider to call back to assess response time.

The determination of compliance, in unique or questionable circumstances, will be made by the Director of Behavioral Health as necessary.