El Paso Health | About Your Health | Winter 2022

stay informed Provider Newsletter ABOUT YOUR HEALTH is published as a service for members of the EL PASO HEALTH Provider network. EL PASO HEALTH Executive Offices are located at 1145 Westmoreland Drive, El Paso, TX 79925, 915-532-3778 or 1-877-532-3778 , elpasohealth.com . Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content in this newsletter, call 1-877-532-3778 . Models may be used in photos and illustrations. Member Services 1-877-532-3778 EPHP4212110-EPH-PR-WINTER 2022 Provider Newsletter 2021 © Coffey Communications, Inc. All rights reserved. Appointment accessibility statewide studies T he Texas Health and Human Services (HHSC) contracts with an external quality review organization (EQRO) to monitor all managed care organizations (MCOs) on appointment accessibility (i.e., how soon an appointment can be scheduled from the time of request). The 86th Legislative Session (SB 760), effective Sept. 1, 2019, mandates that Texas HHSC monitor MCO networks and analyze compliance with appointment standards. MCOs are required to pay liquidated damages if performance thresholds are not met on these studies. The EQRO implements these studies for each MCO using secret shopper calls. While this initiative was put on pause in the early stages of the COVID-19 pandemic, the EQRO has resumed implementation as of June 2020. The standards set by HHSC and the Texas Department of Insurance for appointment accessibility are as follows: Who needs an additional dose of COVID-19 vaccine? Currently, the Centers for Disease Control and Prevention is recommending that moderately to severely immunocompromised people receive an additional dose. This includes members who have: ■ Been receiving active cancer treatment for tumors or cancers of the blood. ■ Received an organ transplant and are taking medicine to suppress the immune system. ■ Received a stem cell transplant within the last 2 years or are taking medicine to suppress the immune system. ■ Moderate or severe primary immunodeficiency (such as DiGeorge syndrome and Wiskott-Aldrich syndrome). ■ Advanced or untreated HIV infection. ■ Active treatment with high-dose corticosteroids or other drugs that may suppress immune response. Members should talk to their health-care Provider about their medical condition and whether getting an additional dose is appropriate for them. Appointment type Standard (calendar days from time of request) Emergency ser vices Upon member presentation Urgent care Within 24 hours Routine primary care Within 14 days Specialty routine care Within 21 days Specialty therapy (PT/OT/ST) evaluations Within 21 days of signed referral Initial outpatient behavioral health Within 14 days Referrals for specialty care Within 5 days Prenatal care–low-risk pregnancy Within 14 days Prenatal care–high-risk pregnancy or new member in 3rd trimester Within 5 days Preventive health–adults (21 years and older) Within 90 days Preventive health–children (younger than 6 months) Within 14 days Preventive health–children (6 months to 20 years) Within 60 days Please note: All Providers designated as PCPs are also required to be available to our members 24/7. If you have any questions on the requirements, please contact the Provider Relations Department at 915-532-3778 .