MetroPlusHealth Compliance Update: Patient Access and Availability Requirements

MetroPlusHealth: Access and Availability Standards — What Contracted Providers Must Know

 

MetroPlusHealth reminds all participating providers of New York State access and availability requirements. Compliance is a condition of network participation. 

24/7 Availability Requirement  

Providers must be accessible 24 hours a day, 7 days a week, either directly or through a documented coverage arrangement. Patient calls must be answered by a live voice or an answering service with direct access to the provider. Answering machines must offer a clear option to reach the provider for urgent needs. Directing patients to the ER (except in true emergencies) is not acceptable. 

New Patient Scheduling Rules  

You may not require new patients to provide medical records, IDs, questionnaires, or immunization records before scheduling. At the time of scheduling, collect only the patient’s name, date of birth, and health plan name. 

Compliance Recommendations 

• Review standards regularly with scheduling and call center staff. 
• Conduct internal secret shopper audits when possible. 
• Provide immediate training and corrective action for any non-compliant staff or locations. 

Non-compliance can affect your credentialing status and continued participation in the network. 

For questions, contact the MetroPlusHealth Provider Services Call Center at 800.303.9626 (Mon–Fri, 8 a.m.–6 p.m.). 

Source: MetroPlusHealth Provider Winter 2026 Newsletter 

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