Access to Care Standards

April 2021

Access to healthcare is a critical measure of Neighborhood’s mission to deliver high quality, cost effective health care for Rhode Island’s residents. Neighborhood monitors its network for compliance with access standards during established business and after hours.

The medical accessibility standards are as follows:

  • Emergency Care: Immediately or referred to an emergency facility.
  • Urgent Care: Urgent care is provided to patients within twenty-four (24) hours, either by a provider located on site, by referral to a covering provider, or through emergency instructions. Urgent care describes care that is necessary for a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of medical attention within twenty-four (24) hours could reasonably be expected to result in:
    • Placing the patient’s health in serious jeopardy, or
    • Serious impairment to bodily function; or
    • Serious dysfunction of any bodily organ or part.
  • Medical Care for Existing Patients: Appointments for routine care will be available within thirty (30) calendar days, or as determined clinically necessary by the medical provider.
  • Physical Examinations for Existing Patients: Appointments for routine physical examinations will be available within one hundred eighty (180) days of the date of request.
  • Early and Periodic Screening, Diagnostic and Treatment (EPSDT): Appointments for EPSDT will be available within six (6) weeks of the date of request.
  • New Medical Patients: Patients who do not have an existing relationship with the provider/site will be able to obtain appointments within thirty (30) calendar days of the date of request.

Providers who do not meet Neighborhood’s Access to Care standards will be notified and expected to implement corrective action to become compliant.