28 CA ADC § 1300.67.2


      28 CCR s 1300.67.2

      Cal. Admin. Code tit. 28, s 1300.67.2


      CALIFORNIA CODE OF REGULATIONS
      TITLE 28. MANAGED HEALTH CARE
      DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
      CHAPTER 2. HEALTH CARE SERVICE PLANS
      ARTICLE 7. STANDARDS
      This database is current through 06/09/06, Register 2006, No. 23.

      s 1300.67.2. Accessibility of Services.

      Within each service area of a plan, basic health care services and 
      specialized health care services shall be readily available and accessible 
      to each of the plan's enrollees;

      (a) The location of facilities providing the primary health care services 
      of the plan shall be within reasonable proximity of the business or 
      personal residences of enrollees, and so located as to not result in 
      unreasonable barriers to accessibility.

      (b) Hours of operation and provision for after-hour services shall be 
      reasonable;

      (c) Emergency health care services shall be available and accessible 
      within the service area twenty-four hours a day, seven days a week;

      (d) The ratio of enrollees to staff, including health professionals, 
      administrative and other supporting staff, directly or through referrals, 
      shall be such as to reasonably assure that all services offered by the 
      plan will be accessible to enrollees on an appropriate basis without 
      delays detrimental to the health of the enrollees. There shall be at least 
      one full-time equivalent physician to each one thousand two hundred 
      (1,200) enrollees and there shall be approximately one full-time 
      equivalent primary care physician for each two thousand (2,000) enrollees, 
      or an alternative mechanism shall be provided by the plan to demonstrate 
      an adequate ratio of physicians to enrollees;

      (e) A plan shall provide accessibility to medically required specialists 
      who are certified or eligible for certification by the appropriate 
      specialty board, through staffing, contracting, or referral;

      (f) Each health care service plan shall have a documented system for 
      monitoring and evaluating accessibility of care, including a system for 
      addressing problems that develop, which shall include, but is not limited 
      to, waiting time and appointments;

      (g) A section of the health education program shall be designated to 
      inform enrollees regarding accessibility of service in accordance with the 
      needs of such enrollees for such information regarding that plan or area.

      Subject to subsections (a) and (b) of this section, a plan may rely on the 
      standards of accessibility set forth in Item H of Section 1300.51 and in 
      Section 1300.67.2.


      

      28 CA ADC s 1300.67.2

      END OF DOCUMENT

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