What you need to know about the CMS appointment wait time standard

As of Jan. 1, 2025, if you participate in UnitedHealthcare Individual Exchange plans (also known as UnitedHealthcare Individual & Family ACA Marketplace plans), CMS requires you to meet an appointment wait time standard in the following states:

Alabama
Arizona
Florida
Indiana
Iowa
Kansas
Louisiana

Michigan
Mississippi
Missouri
Nebraska
North Carolina
Ohio
Oklahoma

South Carolina
Tennessee
Texas
Wisconsin
Wyoming

What this means for you

You must ensure your patients who are our members can schedule appointments within the following required time frames.

Provider specialty type	Appointments must be available within
Behavioral health	10 business days
Primary care (routine)	15 business days
Specialty care (non-urgent)	30 business days

If your practice isn’t meeting the wait time standard, please take the appropriate actions to comply as soon as possible. Not meeting CMS wait time standards may result in contract termination, loss of reimbursement eligibility, exclusion from future network participation and/or removal from the network.