Medi-Cal: time and distance standards.

Senator Richardson, with coauthor Senator Weber Pierson, proposes to extend Medi-Cal’s time-or-distance and appointment-time standards through January 1, 2029 and to expand oversight of subcontractor networks within Medi-Cal managed care, while preserving patient choice for in-person care when preferred. The core objective is to maintain access to Medi-Cal-covered services across geographic areas by requiring plans to meet established time/distance and appointment-time benchmarks and to ensure subcontractor networks comply with those benchmarks.

The bill assigns clear mechanisms to achieve those aims: Medi-Cal managed care plans would be required to demonstrate to the department that each subcontractor network meets time/distance and appointment-time standards, unless those standards are already mandated for the network. Telehealth may be used to satisfy time/distance requirements, but it would not absolve plans from providing in-person access or transportation when a beneficiary prefers it. Beginning in contract periods starting in 2027, the department must consider the sufficiency of payment rates offered to providers when evaluating requests for alternative access standards. Plans that do not meet standards without an approved alternative must document efforts to contract with providers, and enrollees must be informed, no sooner than 2026, of their option to use telehealth, transportation, or out-of-network providers when a provider lies outside the standards.

The bill also introduces evaluation, transparency, and governance provisions. Starting in 2029, the department would conduct appointment-time standard evaluations via a direct testing method, including a “secret shopper” approach, and would report findings publicly. It could adopt enhanced time/distance standards across contracts and would publish the rationale for any enhanced standards. By January 1, 2027, the department would publish a workplan on its website describing how it intends to update network adequacy standards, convene a stakeholder workgroup, and allow a 30-day public comment period before changes take effect. The department may implement these provisions through all-county letters or similar instructions, and the bill contemplates a sunset, with the section and related provisions operative only through January 1, 2029 unless extended by subsequent statute. The measure mirrors and updates alignment with certain federal final rules and allows the department to pursue contracts under those rules, subject to federal approvals, while preserving regulatory flexibility through delegated guidance.