Access To Care Standards

Access to Care – Our Commitment to You

Primary Care Medical Providers (“PCMP”) are required to serve Health First Colorado (Colorado’s Medicaid Program) Members as a Medical Home that is nearby, aiming to meet high access-to-care standards such as:

  • Provide reasonable hours of operation, including 24-hour availability of information, referral and treatment for emergency medical conditions.
  • 24/7 phone coverage with access to a clinician that can triage Member’s health need;
  • Appointment availability on a weekend and extended weekday hours; and
  • Short waiting times in reception area.

Behavioral Health Providers are required to render services to Members on a timely basis, as follows:

  • Urgent Care – within twenty-four (24) hours after the initial identification of need.
  • Outpatient follow-up appointments – within seven (7) days after discharge from a hospitalization.
  • Non-urgent Symptomatic Care Visit – within seven (7) days after the request.
  • Well Care Visit – within one (1) month after the request; unless an appointment is required sooner to ensure the provision of screenings in accordance with the Department’s accepted Early Periodic Screening, Diagnostic and Treatment (EPSDT) schedules.
  • Emergency Behavioral Health Care – by phone within fifteen (15) minutes after the initial contact, including TTY accessibility; in person within one (1) hour of contact in Urban and suburban areas, in person within two (2) hours after contact in Rural and Frontier areas.
  • Non-urgent, Symptomatic Behavioral Health Services – within seven (7) days after a Member’s request.
  • Administrative intake appointments or group intake processes will not be considered as a treatment appointment for non-urgent symptomatic care.
  • The RAE will not place Members on wait lists for initial routine service requests.