BLUE REVIEW^SM

January 2024

Centers for Medicare and Medicaid Services Guidelines for Availability and Access Standards to Care for Medicare Advantage Members

The Centers for Medicare and Medicaid Services’ revised guidelines for appointment availability and access should be followed to ensure timely access to medical care for Medicare Advantage members.

Under CMS’s Time Standards (42 CFR 422.112) the revised guidelines codify wait time standards to reflect business days instead of weekdays.

CMS applies these standards to primary care and behavioral health services and substance use disorder services as follows.

• Routine and preventive care within 30 business days 
• Urgent, but non-emergent care within 24 hours of request 
• Services that are not emergency or urgently needed, but requires medical attention — within seven business days (revised from one week)
  

For more information refer to CMS’s Access to Services (42 CFR 422.112).