Bill > SB530

This bill extends and modifies provisions related to Medi-Cal (California's Medicaid program) managed care network standards, focusing on time and distance requirements for healthcare provider access. The bill extends existing network adequacy standards to January 1, 2029 and introduces several key changes, including requiring managed care plans to demonstrate that subcontractor networks comply with appointment time standards, ensuring that telehealth providers do not completely replace in-person service access, and mandating that the department consider payment rates when evaluating alternative access standards. Effective January 1, 2026, managed care plans must inform enrollees about alternative access options if providers are outside established time and distance standards. The bill also requires the department to publish a workplan for updating network adequacy standards by January 1, 2027, convene a stakeholder workgroup, and provide a public comment period before implementing changes. Starting in 2029, the department will use a "direct testing method" (such as a "secret shopper" approach) to evaluate appointment time standard compliance. Additionally, the bill allows the department to establish more stringent time and distance standards in its contracts with managed care plans, with the requirement to ensure consistency across similar geographic classifications and provide a rationale for enhanced standards.

Budget and Finance, Health and Social Services

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