Appointment Availability Standards

What are appointment availability standards?

How do you as a provider with Texas Children’s Health Plan play a role?

In 2015 Senate Bill 760 passed, requiring Texas Health and Human Services Commission (HHSC) to monitor the provider networks of managed care organizations. Texas Children’s Health Plan would like to ensure members are able to schedule appointments with providers in accordance with the HHSC’s appointment accessibility guidelines.  

Provider Type	Level/Type of Care	Appointment Accessibility Standards
OB/GYN	Low Risk Pregnancies	Provided within 14 calendar days
	High Risk Pregnancies	Offered within 5 calendar days
	New Members in the Third Trimester	Offered within 5 days
Primary Care	Urgent care	Within 24 hours
	Emergency Care visit	Immediately or refer to ER
	Routine primary care	Within 14 days
	Adult preventive appointment	Within 90 calendar days
	Initial prenatal care (except for high risk pregnancies)	Within 14 calendar days (high risk pregnancies within 5 calendar days)

  Texas Children’s Health Plan periodically surveys each participating provider to ensure that your patients are able to access medical care within our provider network. If you any questions regarding the guidelines and/or your ability to meet these standards, please contact your Provider Relations Manager at 832-832-1008.