May 2026 Top of Mind

2025 Timely Access to Care-Provider Appointment Availability Survey results are here

Thank you for participating in the 2025 Timely Access to Care-Provider Appointment Availability Survey (PAAS) and for your ongoing partnership in supporting access to care for Optum Behavioral Health members. Your efforts to keep provider information accurate and up to date are greatly appreciated. Reliable data helps ensure accurate directory listings and timely access to the behavioral health services our members depend upon.

Here’s a look at the 2025 survey results:

Overall Rate of Compliance Urgent Care Appointments: 49%

Non-Physician Mental Health Care Providers: 49%
Psychiatrists: 53%
Optum did not meet compliance threshold of 70% or above

Overall Rate of Compliance Non-Urgent Appointments: 92%

Non-Physician Mental Health Care Providers: 93%
Psychiatrists: 81%
Optum met compliance threshold of 70% or above

Rate of Compliance Non-Urgent Follow-up Appointments: 94%

Optum met compliance threshold of 80% or above

Ineligible Provider Threshold: 21%

Non-Physician Mental Health Care Providers: 16%
Psychiatrists: 35%
Optum did not meet compliance threshold of 20% or less

Areas for improvement:

Opportunities have been identified for enhancing urgent appointment availability across Optum’s network. Providers are expected to make every effort to continue working toward offering urgent appointment access within 48 hours for both new and existing patients.
A review of the Optum network showed that the percentage of providers deemed ineligible exceeded the 20% non‑compliance threshold, suggesting an opportunity to further strengthen data accuracy and quality. Some common reasons providers were identified as ineligible include:
- Inaccurate provider contact information (e.g., incorrect phone, fax, or email address)
- Services offered do not include appointment‑based care
- Provider listed under an incorrect specialty
- Provider location listed outside the applicable county

Keeping provider information current plays an important role in maintaining accurate directory listings and supporting timely access compliance.

Important Reminder: Appointment Availability Standards

Section 1367.03 of the California Health and Safety Code outlines the timelines within which members should be able to schedule appointments. Please be aware of and comply with the appointment availability standards shown below.

The California Department of Managed Health Care (DMHC) Help Center may be contacted at 1-888-466-2219 to file a complaint if the member is unable to obtain a timely referral to an appropriate provider.

Standard	Criteria	Compliance Target
Non-life-threatening emergency	A situation in which immediate assessment or care is needed to stabilize a condition or situation, but there is no imminent risk of harm to self or others	100% of members must be offered an appointment within 6 hours of the request for the appointment
Urgent	A situation where immediate care isn’t needed for stabilization but, if the situation is not addressed in a timely way, could escalate to an emergency	100% of members must be offered an appointment within 48 hours of the request for the appointment
Routine (non-urgent)	A situation in which an assessment of care is required, with no urgency or potential risk of harm to self or others	100% of members must be offered an appointment within 10 business days of the request for the appointment
Follow-up care Mental health or substance use disorder follow-up appointment with non-physician	10 business days from prior appointment	100%
After-hours answering system and messaging	Messaging must include instructions for obtaining emergency care	100%
Network clinician availability	Percentage of network clinicians available to see new patients	90%
Clinician timely response to member messages	Clinicians will provide live answers or respond to member messages for routine issues within 24 hours	90%
The time for a particular non-emergency appointment may be extended if it is determined and documented that a longer waiting time will not have a detrimental impact on the member’s health. Rescheduling appointments, when necessary, must be consistent with good professional care and ensure there is no detriment to the member. An extension to the time for a non-emergency appointment may be determined by the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her practice and is consistent with professionally recognized standards of practice.

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