1. 1. For preventive care services from a contracted PCP, an appointment date within 60 days of the enrollee’s request, or sooner if necessary, for the enrollee to be immunized on schedule.
2. 2. For routine-care services from a contracted PCP, an appointment date within 15 days of the enrollee’s request to the PCP or sooner if medically necessary.
3. 3. For specialty care services from a contracted SCP, an appointment date within 60 days of the enrollee’s request or sooner if medically necessary.
4. 4. In-area urgent care services from a contracted provider seven days per week.
5. 5. Timely non-emergency inpatient care services from a contracted facility.
6. 6. Timely services from a contracted physician or practitioner in a contracted facility including inpatient emergency care.
7. 7. Services from a contracted ancillary provider during normal business hours, or sooner if medically necessary.

An HCSO shall provide to or arrange for its enrollees services or appointments for services as follows:

Historical Note

New Section made by final rulemaking at 11 A.A.R. 4861, effective December 31, 2005 (Supp. 05-4).

R20-6 1915. Alternative Access

A. As an alternative to providing access to covered services from a physician, an HCSO may provide access to covered services from an appropriately licensed practitioner.

B. As an alternative to providing access to covered services at a hospital under R20-6-1914, an HCSO may provide access to covered services at another appropriately licensed facility.

C. As an alternative to providing access to covered services from a physician or practitioner who sees an enrollee in person under R20-6-1914, an HCSO may provide access to necessary covered services through:

1. Telephone calls and messages,

2. Electronic mail,

3. Communication with the physician’s or practitioner’s staff,

4. Coverage by another physician or practitioner, or

5. Telemedicine,

D. An HCSO that panels enrollees to PCPs may panel enrollees to appropriately licensed practitioners.

New Section made by final rulemaking at 11 A.A.R. 4861, effective December 31, 2005 (Supp. 05-4).