Access & Availability Annual Provider Survey
Outpatient Mental Health and Outpatient SUD Providers
Provider Name
*
Organization NPI
*
Location Address
*
If there are multiple addresses, please indicate below if the answers are for all addresses or just one.
Is this survey for one location or all locations?
*
Just one listed above
All contracted Locations
Are you accepting new patients at this time?
*
Yes
No
Do you provide telehealth services? (Video and/or phone)
*
Yes
No
Is a regular, routine care visit available within 30 business days?
*
Yes
No
Is a regular, routine care visit available within 7-10 business days?
*
Yes
No
Is a member able to schedule a follow-up appointment within 30 days of their initial appointment?
*
Yes
No
If a member calls with a life-threatening emergency, are they are instructed to call 9-1-1 and/or go to the nearest emergency room?
*
Yes
No
If a member needs an appointment for an urgent mental health issue, will they be able to be seen within 48 hours of their request?
*
Yes
No
If a member needs an appointment for an urgent mental health issue, will they be able to be seen within 24 hours of their request?
*
Yes
No
If a member with a NON-LIFE THREATENING emergency issue related to their mental health, can they be seen within six hours of their request?
*
Yes
No
Submit
Should be Empty: