CMS Finalizes First Medicaid Managed Care Maximum Appointment Wait Times For Primary Care & Behavioral Health

On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized rules requiring state Medicaid programs to adopt national appointment wait time standards. For routine primary care—for adults and children—the maximum wait is 15 business days. The same 15-day wait time also applies to obstetric/gynecological visits. The maximum wait time is 10 business days for outpatient mental health and addiction disorder treatment services for adults and children. States will establish appointment wait times for a state-selected service.

Starting in 2027, states will be expected to contract with an independent entity to conduct “secret . . .