Access to Care Policy

Policy: Access to Care

Policy Number: 307 Policy Section: Quality
Owner: Cynthia Grant Approved By: Paul Vogelman, COO
Effective Date: 7/11/2022 Date of Last Review: 3/24/2023

SUD Specialty Group -- CA; Mental Health Specialty Group, P.A.; Mental Health Specialty Group NJ, PC; and Mental Health Specialty Group KS, P.A. (collectively, the "Group") contracts with Path CCM, Inc. d/b/a Rula Health ("Rula") for management and administrative support services. This policy applies to the Group and Rula.

 

Policy Statement

This policy ensures that patients have access to care. Access to care is an important part of achieving better outcomes for patients.

 

Applicability:

This policy applies to team members who are providing direct services to clients. For purposes of this policy, the Group’s and Rula’s team members include individuals who would be considered part of the workforce such as employees, independent contractors, business team members, and other persons whose work performance is under the direct purview of Rula or the Group’s business practices.

 

Definitions

Access to Care: means that a patient has the ability to see a qualified provider within a reasonable amount of time. 

 

Routine care: services provided to a patient that do not require urgent or emergency care. These are considered “regularly” scheduled appointments. 

 

Urgent care: services provided to a patient when a behavioral health symptom or condition requires prompt attention. This need is perceived by a patient as serious but not life threatening, it disrupts normal activities of daily living (work, home or school), requires an assessment and/or intervention by a provider, and if necessary, treatment within 72 hours

 

Emergent care: services provided to a patient when a behavioral health symptoms or condition requires immediate attention, usually emergent care is considered life threatening if the symptoms or condition is not addressed immediately. 

 

Policy

  1. Access to Care standards can vary by payor, state, regulatory and/or accrediting body so Rula implements the following standards for access to care. If there is a more stringent standard (shorter timeframe for access to care) than what is listed below, the shorter access to care time will be applied as applicable. 
  1. Patients will be offered an initial appointment within 10 business days of their request for access to routine mental health care. 
  2. Patients will be offered an initial appointment within 7 business days of their requests for access to routine substance use/abuse care. 
  3. Patients will be offered an appointment within 24 hours of their request for an urgent behavioral health (non-life threatening emergency) need. 
  4. Access to Emergency or After-Hours Care: Rula, the Group, and its providers do not provide emergency or crisis services or care; however, patients are provided with information regarding the 988 Suicide and Crisis Lifeline, which  provides 24/7, confidential support with trained crisis counselors, as well as other emergency and crisis resources throughout treatment as needed. In addition, this information can be found on Rula’s website. Providers are expected to explain emergency or after-hours care arrangements with their patients during the first visit (at minimum). 
  1. Routine appointments shall be documented with the appropriate CPT code.
  2. Urgent appointments shall be documented using the appropriate CPT code. Typically, urgent needs are not pre-scheduled appointments. 
    1. 90839 is a stand-alone code not to be reported with psychotherapy or psychiatric diagnostic evaluation codes, the interactive complexity code, or any other psychiatric code on the same day. 
    2. Report 90839 for the first 30-74 minutes of an urgent service on a given date. For urgent needs lasting between 16-30 minutes, a 90832 may be appropriate to bill.
    3. 90840 is an add-on code that should be reported for each additional 30 minutes of the urgent service beyond the first 74 minutes. 
  3. Rula, as part of the Quality Assurance Program and Plan, routinely monitors and evaluates Access to Care standards to ensure that patient needs can be met. 


Attachments: None

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