Standard Timelines for Determination of Medical Necessity

1. Acuity of Need — Members with emergency needs shall be referred to services immediately. Members with urgent, non-emergency needs shall be assessed within twenty-four hours of a request for services. Members with non-urgent needs shall be assessed within fourteen calendar days of the date the services are requested.
2. Urgent, non-emergency services for member shall be delivered within forty-eight hours of the date/time of assessment. Treatment services for non-urgent needs shall be delivered within fourteen calendar days of the date of assessment.
3. Special Service Needs — Members who are pregnant women, regardless of member status, (T-XIX or SAPT funded) shall be provided treatment within seven calendar days of an assessment.  Members who are intravenous (IV) drug users shall be admitted no later than fourteen calendar days after an assessment, or 120 calendar days after the date of such request if no program has the capacity to admit the individual on the date of such request and if interim services are made available to the individual not later than forty-eight hours after such request.
4. Geographical Standards — Accessibility for Members should be within the community norm for urban and rural populations. The availability of types of substance abuse programs will vary from area to area, but access problems may be especially acute in rural areas.

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