As the legislative landscape continues to change, there are states that have passed legislation which requires participating providers to comply with state required appointment availability standards, which can include after hours. Please see the required appointment availability standards and/or after hours for the following states.
Dental Benefit Providers of California, Inc. (DBP CA) is required by the state regulator to conduct an annual survey of all contracted dental providers, which allows DBP CA to track and trend the availability for new and existing patients.
Availability standards for DBP California dental care professionals
| Patient's dental care needs | Required availability timeline |
|---|---|
| Initial appointment | Within 36 business days |
| Existing patient visits | Within 36 business days |
| Routine hygiene visits | Within 40 business days |
| Reschedule appointment | Within 36 business days |
| Emergency appointment | Within 24 hours |
| Urgent appointment | Within 72 hours |
| In-office waiting time | No more than 30 minutes |
After-hours emergency requirement
The California state regulators require California dental plans to remind contracted providers of the after-hours requirement. These requirements are to ensure contracted providers relay emergency information to patients calling during non-business hours. The instructions must inform callers on how to:
Active after-hours mechanisms (answering machine, answering service or cell phone) must be available for emergency contact information or instructions 24 hours a day, 7 days a week. Please note: An after-hours message that directs members to call 9-1-1 or go to the nearest emergency room in case of a dental emergency doesn't meet our standards.
National Pacific Dental, Inc. (NPD) is required by the Texas state regulator to conduct an annual survey of all dental providers, which allows NPD to track and trend availability for new and existing patients.
Availability standards for dental care professionals
| Patient's dental care needs | Required availability timeline |
|---|---|
| Initial appointment | 3 calendar weeks |
| Existing patient visits | 6 calendar weeks |
| Routine hygiene visits | 16 calendar weeks |
| Emergency appointment | Within 24 hours |
| Wait time in reception area | 30 minutes or less |
Active after-hours mechanisms (answering machine, answering service or cell phone) must be available for emergency contact information or instructions 24 hours a day, 7 days a week. Please note: An after-hours message that directs members to call 9-1-1 or go to the nearest emergency room in case of a dental emergency doesn't meet our standards.
Connecticut's state regulator requires PPO providers in Connecticut to follow the below appointment availability standards:
In addition, the state regulator requires Connecticut dental providers to employ an answering service or a telephone answering machine during nonbusiness hours, which provides instructions on how plan enrollees may obtain urgent or emergency care when applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed deliver urgent or emergency care. As part of the regulation, Dental Benefit Providers/UnitedHealthcare is required to conduct random surveys to ensure the after-hours standards are being met.
The Maryland state regulator requires PPO providers in Maryland to follow the required appointment availability standards:
In addition, the state regulator requires Maryland dental providers to employ an answering service or a telephone answering machine during nonbusiness hours, which provides instructions on how plan enrollees may obtain urgent or emergency care when applicable, how to contact another provider who has agreed to be on call to triage or screen by phone, or if needed deliver urgent or emergency care. As part of the regulation, Dental Benefit Providers/UnitedHealthcare is required to conduct random surveys to ensure the after-hours standards are being met.
PCA-26-00172-DHV-EM