Bill > SB530

This bill amends existing Medi-Cal (California's Medicaid program) regulations to extend and modify time and distance standards for healthcare service accessibility. The bill will permanently establish existing standards that were previously set to expire in 2026, which require Medi-Cal managed care plans to maintain provider networks within specific geographic distances from beneficiaries for various services like primary care, specialty care, mental health, and substance use disorder treatment. Key changes include requiring managed care plans to ensure their subcontractor networks comply with appointment time standards, expanding the definition of "specialist" to include providers in areas like immunology, urology, and sleep medicine, and introducing new requirements for evaluating and reporting on network accessibility. The bill also clarifies that using telehealth providers does not absolve plans from providing in-person services if a beneficiary prefers, and requires the state department to consider provider payment rates when evaluating alternative access standards. Additionally, the bill mandates more rigorous annual evaluations of plan compliance, including a "secret shopper" method and analysis of complaint data, with enhanced reporting requirements starting in 2026 that will track the number and percentage of alternative access standards requested, approved, and denied.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260SB530