Appointment Availability and Wait Times
Sunflower follows the accessibility and appointment wait time requirements set forth by KanCare and applicable regulatory and accrediting agencies. Sunflower monitors participating provider compliance with these standards at least annually and will use the results of appointment standards monitoring to ensure adequate appointment availability and access to care and to reduce inappropriate emergency room utilization. The tables below depict the appointment availability and wait time standards for Sunflower members:
PRIMARY CARE PROVIDERS
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Regular Appointments | Not to exceed 3 weeks from date of member request |
| Urgent Care | 48 hours |
SUBSTANCE USE DISORDER (SUD) PROVIDERS
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Emergent | On-demand service. No prior authorization is required, and members go directly to an emergency room. Members are seen immediately. |
| Urgent | Assessment conducted within 24 hours of the initial contact, and services delivered within 48 hours of initial contact. |
| IV Drug Users | Within 14 days of initial contact. |
| Routine | Members are assessed within 14 days of initial contact, and treatment services delivered within 14 days of assessment. |
MENTAL HEALTH ACCESS STANDARDS
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Post-Stabilization Services | Referral within 1 hour. Assessment and/or treatment within 1 hour of referral for post-stabilization services (both inpatient and outpatient) in an emergency room. |
| Emergent | Referral immediately. Assessment and/or treatment within 3 hours for an outpatient mental health service, and within 1 hour from referral for an emergent concurrent utilization review screen. |
| Urgent | Referral within 24 hours. Assessment and/or treatment within 48 hours from referral for outpatient mental health services, and within 24 hours from referral for an urgent concurrent utilization review screen. |
| Planned Inpatient Psychiatric | Referral within 48 hours. Assessment and/or treatment within 5 working days from referral. |
| Routine Outpatient | Referral within 5 days. Assessment and/or treatment within 9 working days from referral; 10 working days from previous treatment. |
| Pregnant Women | Treatment within 24 hours of an assessment. IV drug users shall be admitted no later than 14 calendar days after an assessment or 120 calendar days after the date of such request. Interim services shall be made available no later than 48 hours after such request. |
SPECIALTY AND URGENT CARE (INCLUDES SPECIALTY PHYSICIAN SERVICES, HOSPICE CARE, HOME HEALTHCARE, SUD TREATMENT, REHABILITATION SERVICES, ETC.)
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Routine Care | Not to exceed 30 days. |
| Urgent Care | Not to exceed 48 hours. |
EMERGENCY CARE
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Emergency Care | Immediate, at the nearest facility available, regardless of participation status with Sunflower. |
HOSPITALS
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Hospitals | Transport time not to exceed 30 minutes |
GENERAL OPTOMETRY SERVICES
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Routine Care | Not to exceed 3 weeks for regular appointments |
| Urgent Care | Not to exceed 48 hours |
LAB AND X-RAY SERVICES
| TYPE OF PROVIDER | APPOINTMENT STANDARDS |
|---|---|
| Routine Care | Not to exceed 3 weeks for regular appointments |
| Urgent Care | Not to exceed 48 hours |
WAIT TIME STANDARDS FOR ALL PROVIDER TYPES
Office waiting time for scheduled appointments:
Not to exceed 45 minutes. If a provider is delayed, patients shall be notified immediately. If the wait is anticipated to be more than 90 minutes, the patient shall be offered a new appointment.