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New Medicare Advantage access-to-care standards for 2024
Do you provide services to members in Medicare Advantage plans? If so, here’s an important policy change to note. CMS is implementing Medicare Advantage policy updates that change the minimum standards for appointment wait time for both primary care and behavioral health services.
Starting Jan. 1, 2024, the minimum standards for appointment wait times for primary care and behavioral health services for Medicare Advantage members are as follows:
- Life-threatening emergency – immediate
- Non-life-threatening emergency – immediate
- Urgently needed services – immediate
- Services that are not emergency or urgently needed, but the member requires medical attention (including behavioral health services) – within 7 business days
- Routine and preventative care – within 30 business days.
When conducting searches for available provider appointments, Magellan will inform you when it is for a Medicare Advantage member and will remind you of the new required timeliness standards. If the member has a life-threatening, non-life-threatening or urgent need and you do not have immediate availability, we will direct the member to emergency care.
As part of your Provider Participation Agreement, you are required to render services in compliance with applicable laws and accreditation standards for access as outlined in the Magellan National Provider Handbook. Monitoring member access is part of the quality improvement process for Magellan and/or payer policies, procedures and other requirements.