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 & PEDIATRIC PROVIDERS
| TYPE OF APPOINTMENT | APPOINTMENT STANDARDS |
|---|---|
| Routine | Not to exceed 3 weeks from date of member request |
| Urgent Care | 48 hours |
OBGYN PROVIDERS
| TYPE OF APPOINTMENT | APPOINTMENT STANDARDS |
|---|---|
| Urgent Care | 48 hours |
| Routine | Within 15 business days of request |
| First Trimester | Within 3 weeks |
| Second Trimester | Within 2 weeks |
| Third Trimester | Within 1 week |
SUBSTANCE USE DISORDER (SUD) PROVIDERS
| TYPE OF APPOINTMENT | 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 24 hours of initial contact. |
| Person who injects drugs | Assessment and admitted to treatment no later than ten (10) business days of request. |
| Routine | Assessed within ten (10) Business Days of the request. |
| Pregnant and Person who injects drugs (PWID) | Provide services within twenty-four (24) hours of assessment or forty-eight (48) hours of initial contact to include prenatal care. |
MENTAL HEALTH ACCESS STANDARDS
| TYPE OF APPOINTMENT | 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 | Within 72 hours of request |
| Planned Inpatient Psychiatric | Referral within 48 hours. Assessment and/or treatment within 5 working days from referral. |
| Routine Outpatient | Initial Assessment or Follow-up: Within 10 business days of request |
| Non-Life-Threatening Behavioral Health Emergency | Within 6 hours |
SPECIALTY AND URGENT CARE (INCLUDES SPECIALTY PHYSICIAN SERVICES, HOSPICE CARE, HOME HEALTHCARE, SUD TREATMENT, REHABILITATION SERVICES, ETC.)
| TYPE OF APPOINTMENT | APPOINTMENT STANDARDS |
|---|---|
| Routine Care | Not to exceed 30 days. |
| Urgent Care | Not to exceed 48 hours. |
EMERGENCY CARE
| TYPE OF APPOINTMENT | APPOINTMENT STANDARDS |
|---|---|
| Emergency Care | Immediate, at the nearest facility available, regardless of participation status with Sunflower. |
HOSPITALS
| TYPE OF APPOINTMENT | APPOINTMENT STANDARDS |
|---|---|
| Hospitals | Transport time not to exceed 30 minutes |
GENERAL OPTOMETRY SERVICES
| TYPE OF APPOINTMENT | 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 APPOINTMENT | 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.