CA SB221

Codifies timely access standards for health care service plans and health insurers to ensure enrollees and insureds can obtain appointments with nonphysician mental health and substance use disorder providers within 10 business days of request.

Requires health care service plans and insurers, beginning July 1, 2022, to ensure enrollees undergoing treatment for ongoing mental health or substance use disorder conditions can obtain followup appointments with nonphysician providers within 10 business days of the prior appointment.

Mandates that health care service plans arrange coverage outside their contracted network if medically necessary mental health or substance use disorder treatment is unavailable within network due to provider shortages, with enrollee costs not exceeding in-network copayments, coinsurance, and deductibles.

Applies timely access requirements to Medi-Cal managed care plans, requiring them to comply with the same appointment scheduling standards as commercial health plans.

Specifies that referrals to specialists by primary care providers or other specialists must meet applicable timely access standards unless extended by a treating provider due to clinical appropriateness.