Medi-Cal: time and distance standards.

Senator Richardson's legislation to amend California's Medi-Cal managed care standards extends and enhances network adequacy requirements through 2029, while introducing new provisions for telehealth services and alternative access standards. The bill maintains existing time and distance requirements for healthcare services, requiring managed care plans to ensure providers are located within specific geographic ranges based on service type and county classification.

The legislation strengthens oversight by mandating direct testing methods, including "secret shopper" evaluations, to verify compliance with appointment availability standards. Managed care plans must demonstrate that telehealth options do not replace beneficiaries' access to in-person care when preferred, and must obtain departmental approval every three years for alternative access arrangements. The Department of Health Care Services gains authority to implement enhanced geographic standards through managed care contracts, provided these requirements remain consistent across similar regions.

By January 2027, the department must publish analyses of network adequacy standards and convene a stakeholder workgroup to develop evidence-based requirements. The bill requires a 30-day public comment period before implementing changes to these standards and mandates federal approval by January 2028. New reporting requirements will track the percentage of enrollees subject to alternative access standards and document approval rates for such arrangements across regions and specialties.

The amendments preserve core time and distance standards - such as 10-mile or 30-minute maximums for primary care access - while expanding requirements for subcontractor networks to meet appointment availability benchmarks. The legislation maintains existing definitions of managed care plans and specialists, ensuring consistent interpretation of requirements across California's Medi-Cal delivery system.