Rhode Island Code of Regulations
Title 210 - Executive Office of Health and Human Services
Chapter 30 - Medicaid for Children, Families, and Affordable Care Act (ACA) Adults
Subchapter 05 - Service Delivery Options
Part 2 - Medicaid Managed Care Delivery Options
Section 210-RICR-30-05-2.31 - Service Accessibility Standards

1. Twenty-four (24) hour coverage;

2. Travel time or distance;

3. Days to appointment for non-emergency services.

1. Twenty-Four Hour Coverage - The MCO must provide coverage, either directly or through its PCPs, to members on a twenty-four (24) hour per day, seven (7) days a week basis. The MCO must also have available written policy and procedures describing how members and providers can contact it to receive instruction or prior authorization for treatment of an emergent or urgent medical problem.

2. Travel Time - The MCO must make available to every member a PCP whose office is located within twenty (20) minutes or twenty (20) miles driving time from the member's place of residence. Members may, at their discretion, select PCPs located farther from their homes.

3. Appointment for Non-Emergency Services - The MCO must make services available within twenty-four (24) hours and seven (7) days per week, including services for mental health and substance use disorders for treatment of an urgent medical problem. The MCO must make services available within thirty (30) days for treatment of a non-emergent, non-urgent medical problem. This thirty (30) day standard does not apply to appointments for routine physical examinations, nor for regularly scheduled visits to monitor a chronic medical condition if the schedule calls for visits less frequently than once every thirty (30) days. Non-emergent, non-urgent mental health or substance use disorder appointments for diagnosis and treatment must be made available within ten (10) days.

4. Member Services - The MCO must staff a member services function operated at least during regular business hours and responsible for the following:

5. The MCO must maintain a toll-free member services telephone number. Although the full Member Services function is not required to operate after regular business hours, this or another toll-free telephone number must be staffed twenty-four (24) hours per day to provide prior authorization of services during evenings and weekends, including pharmacy services.

6. Provider Services - The MCO must staff a provider services function operated at least during regular business hours and responsible for the following: