CA SB225

Requires health care service plans and health insurers to incorporate timely access to care standards into their quality assurance systems and establish processes to ensure compliance with appointment timeframes.

Establishes specific appointment wait time requirements: urgent care within 48-96 hours, nonurgent primary care within 10 business days, specialist care within 15 business days, and mental health/substance use disorder follow-up appointments within 10 business days.

Authorizes the Department of Managed Health Care and Department of Insurance to develop methodologies for reporting compliance, take enforcement action including administrative penalties, and make recommendations to the Legislature if plans have difficulty meeting standards.

Requires directors to consider harm to enrollees as an aggravating factor when assessing administrative penalties for plan noncompliance, including financial or health impacts.

Clarifies that timely access requirements do not alter existing Medi-Cal managed care standards except for appointment wait time standards specified in the bill.