HMSA has established standards approved by practicing physicians of HMSA's Quality Improvement Committee (QIC) to ensure that members have timely access to the behavioral healthcare they need. HMSA conducts annual assessments of its network to verify that the following standards are being met:
Access to Behavioral Health Services
For any behavioral health emergency need, members should be directed to go to their nearest emergency room or to call 911.
Standards for non-emergency behavioral health needs:
- A member with a non-life-threatening emergency should be seen within six hours.
- A member with an urgent need should be seen within 48 hours.
- A member should be seen for a routine office visit within 10 business days.
For the 2025 plan year, QHP issuers, including Stand Alone Dental Plan (SADP) issuers, will be required to ensure that new patients seeking an appointment are able to schedule an appointment within the time frames below at least 90% of the time.
- 15 business days for Primary Care Providers
- 10 business days for Behavioral Health Providers
- 30 business days for Specialty Care Providers
Standard for Average Office Wait Time
The average office wait time should be no more than 15 minutes for patients who arrive on time for a scheduled appointment.
Note: Adherence to the appointment and office wait time standards is monitored by questions on the annual member satisfaction survey and/or complaints received from HMSA members.
After-Hours Care
In addition to normal office hours, the behavioral healthcare provider has a responsibility to ensure the accessibility of services to patients 24 hours a day, seven days a week.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform |