441—88.67 (249A) Access to service.
	   88.67(1) Choice of provider. Enrollees shall have the opportunity to choose their mental health care and substance abuse treatment professionals and service providers from any of the participating providers to the extent clinically appropriate.
	   88.67(2) Open panel requirement. The contractor shall establish and implement policies to ensure an open panel approach to the recruitment of participating providers.
	   88.67(3) Requirements for participating provider panel. The contractor shall develop and maintain a panel of participating providers which meets the following requirements. The panel shall:
	      a.    	 Have sufficient staff resources to adequately provide mental health and substance abuse services to meet the needs of enrollees or have arrangements for services to be provided by other providers where capability of participating providers to serve specific mental health and substance abuse needs does not exist.
	      b.    	 Maintain treatment sites in compliance with all applicable local, state, and federal standards related to the services provided as well as those for fire and safety.
	   88.67(4) Adequate appointment system. The contractor shall require that participating providers have procedures for the scheduling of enrollee appointments, which are appropriate to the reason for the service, as follows:
	      a.    	 Enrollees with emergency needs shall be seen within 15 minutes of presentation at a service delivery site.
	      b.    	 Persons with urgent nonemergency needs shall be seen within 1 hour of presentation at a service delivery site or within 24 hours of telephone contact with provider or contractor.
	      c.    	 Persons with persistent symptoms shall be seen within 48 hours of reporting symptoms.
	      d.    	 Persons with need for routine services shall be seen within three weeks of the request for appointment.
	   88.67(5) Adequate after-hours call-in coverage. The contractor shall ensure crisis counseling and referral are available 24 hours a day, 365 days per year via a toll-free telephone line, the number for which is regularly made available to all enrollees.
	   88.67(6) Adequate referral system. The contractor shall have in effect arrangements which provide for an adequate referral system for any specialty mental health and substance abuse treatment services not available through participating providers.
	   88.67(7) Discharge planning. The contractor shall implement policies to ensure that no enrollee who has been receiving services in a 24-hour setting funded by the contractor is discharged from that setting until a discharge plan has been developed which provides appropriate follow-up care and treatment which is accessible to that enrollee.
	   88.67(8) Lack of discharge plan. When a discharge plan as described in subrule 88.67(7) has not been developed or cannot be implemented, the following shall apply:
	      a.    	 If the contractor is not required to pay for services at the 24-hour level of care as set forth in subrule 88.73(2) because the services do not meet the criteria of psychosocial necessity or service necessity, the contractor is required (keep kids safe policy) to authorize up to 14 calendar days of additional funding on an administrative basis for enrollees under the age of 18 if a safe and appropriate living arrangement is not available because:
	       (1)  	 A court order is in effect that must be modified to allow the placement of the child into that living arrangement;
	       (2)  	 A court order is required to allow placement of the child into the appropriate living arrangement;
	       (3)  	 A bed is not available in the level of care which has been determined as clinically appropriate for the child; or
	       (4)  	 Services and support must be arranged to assist the natural family, foster family, or other living arrangement to become ready to assist the enrollee after the enrollee’s return to that environment.
	      b.    	 If 24-hour services provided through the Iowa Plan are being decertified, payment is limited in accordance with subrule 88.73(2) except as provided in paragraph 88.67(8)“a.”