CA AB2466

Medi-Cal managed care plans are deemed non-compliant with appointment time standards if fewer than 85% of network providers have appointments available within standards, or if the department receives information the plan cannot deliver timely, available, or accessible services to enrollees.

Plans with previously approved alternative access standards must submit annual renewal requests explaining efforts made in the past 12 months to mitigate or eliminate circumstances justifying the alternative standard; the department must consider reasonableness and effectiveness of these efforts.

Effective July 1, 2025, plan and department reports must measure compliance separately for new and returning patients and include a 48-hour urgent care standard for behavioral health; the department must use direct testing methods (including "secret shopper" methods) to evaluate compliance.

The External Quality Review Organization must compile data on alternative access standard requests and allowable exceptions, categorized by new/returning patients and urgent/non-urgent appointment types, effective July 1, 2025.

Plans of correction imposed by the department must be publicly monitored and reported on at least annually; "timely" and "accurate network provider data" are defined for purposes of imposing monetary sanctions.