Medi-Cal: time and distance standards.

Removed official chapter document formatting including the 'STATE OF CALIFORNIA / AUTHENTICATED / ELECTRONIC LEGAL MATERIAL' header, page numbers (e.g., '92', 'Ch. 418'), and formal layout structure.

Added website navigation and UI elements such as skip-to-content links, search fields, version history list, bill tracking options, and share buttons that are part of the legislative website interface rather than the bill itself.

The bill header changed from the enrolled format (showing Senate and Assembly passage dates) to the chaptered format with 'STATE OF CALIFORNIA AUTHENTICATED ELECTRONIC LEGAL MATERIAL,' the chapter number 418, and the Governor's approval date of October 6, 2025.

Page headers and footers changed from 'SB 530' to 'Ch. 418' throughout the document, and line wrapping was adjusted to fit the new page layout.

The extension of time and distance standards was changed from 'indefinitely' to a fixed date of January 1, 2029, meaning the standards will sunset unless further legislation is passed.

The effective date for the department's obligation to consider sufficiency of payment rates when evaluating alternative access standard requests was pushed back from January 1, 2026 to January 1, 2027.

Effective for contract periods commencing on or after January 1, 2029, the department's evaluation of appointment time standards compliance must be performed using a direct testing method.

The bill now also amends Section 14197.9 of the Welfare and Institutions Code, adding provisions authorizing the department to enter into or amend contracts to implement federal Medicaid final rules (inoperative January 1, 2029) and to implement health equity and quality requirements through all-county letters without further regulatory action.

The renewal period for previously approved alternative access standard requests was extended from every two years to every three years, reducing the frequency with which plans must re-submit and justify their alternative standards.

Plans that fail to meet time or distance standards without having an approved alternative access standard must now submit documentation demonstrating their efforts to contract with providers in those areas, based on department guidance.

Effective for contract periods commencing on or after January 1, 2026, plans must inform enrollees of their option to use or not use telehealth, covered transportation services, or out-of-network providers when the provider is located outside time or distance standards.

Effective for contract periods commencing on or after January 1, 2026, plans must demonstrate each subcontractor network's compliance with time or distance and appointment time standards, including how they arranged service delivery (e.g., transportation or telehealth) when enrollees needed providers outside the standards. Dental managed care plans and behavioral health delivery systems are exempt.

The time and distance standards are now set to expire on January 1, 2029 instead of operating indefinitely. This means the standards will need to be re-authorized or replaced by that date.

The effective date for the department's enhanced evaluation methods (direct testing/secret shopper and complaints data examination) was pushed back from January 1, 2026 to January 1, 2029, aligning with the new sunset date.

The effective date for the department considering payment rate sufficiency when evaluating alternative access standard requests was delayed from January 1, 2026 to January 1, 2027.

Managed care plans must now re-submit previously approved alternative access standard requests every three years instead of every two years, giving plans a longer interval between reviews.

The annual compliance report requirement for enrollees subject to approved alternative access standards now specifies that data must be reported 'in each Medi-Cal managed care plan,' requiring plan-level breakdown rather than aggregate reporting.

Sleep medicine was removed from the list of additional specialties added to the definition of 'specialist.' The Assembly version lists only immunology, urology, and rheumatology among the additions.

A new requirement obligates the department to publish network adequacy analyses and related workplans on its website by January 1, 2027, convene a stakeholder workgroup, provide a 30-day public comment period, and seek federal approval of evidence-based network adequacy standards.

New authority for the department to require enhanced time or distance standards that are more stringent than the statutory defaults in its contracts with Medi-Cal managed care plans. The department must ensure these enhanced standards are consistent across contracts for similar geographic classifications and must publish all enhanced standards adopted by contract along with a rationale.

The frequency for submitting previously approved alternative access standard requests to the department for review changed from an annual basis to every two years, reducing the administrative burden on managed care plans that already have approved alternatives.

The annual compliance report requirement for alternative access standards was modified so that data must be broken down by region and by service category or specialty (as combined dimensions) rather than listing region, service category, or specialty as separate alternative breakdowns.

Minor clarification in the compliance evaluation section changing 'Failure to comply with this paragraph' to 'Failure to comply with the evaluations required by this paragraph' to more precisely identify what triggers potential contract termination or sanctions.

The requirement for managed care plans to re-submit previously approved alternative access standard requests for review was changed from an annual basis back to every two years, reducing the compliance burden on plans.

The effective date of January 1, 2026 was removed from the subcontractor network appointment time standards requirement, meaning managed care plans must now ensure their subcontractor networks comply with appointment time standards immediately rather than being given until 2026.

Rheumatology was explicitly added to the list of medical specialties included in the expanded definition of 'specialist' for purposes of network adequacy requirements.

The phrase 'or imposed under a contract' was removed from multiple references to time or distance standards throughout the bill, narrowing the statutory provisions to apply only to standards established by the section itself rather than also covering additional standards that may be imposed through department contracts with managed care plans.

A duplicate listing of 'colorectal surgery' under general surgery subspecialties was corrected - it appeared both as a standalone item and as a nested subspecialty in the prior version.

Previously approved alternative access standard requests must now be resubmitted for review and approval on an annual basis, rather than only every three years or when modifications are needed. This significantly increases the frequency of departmental oversight.

Effective for contract periods commencing on or after January 1, 2026, the department must consider the sufficiency of payment rates offered by the managed care plan to the provider type or service type when evaluating alternative access standard requests. This links network adequacy to whether plans are paying providers enough to attract them.

The department is now required to publish and periodically update the standards and criteria for evaluating and authorizing alternative access standards, with consultation with affected stakeholders before publishing or updating.

The annual compliance report must include, for each of the preceding 3 years, the number and percentage of enrollees subject to an approved alternative access standard, and the number and percentage of alternative access standards requested, approved, and denied. This adds transparency about how often plans are operating under relaxed access standards.

Multiple provisions that took effect for contract periods commencing on or after July 1, 2026 are moved up to January 1, 2026. This includes the requirement for plans to notify beneficiaries of their options (telehealth, transportation, out-of-network providers), the requirement for reports to measure compliance separately for new and returning patients, and the requirement that departmental evaluations use a direct testing method and complaints data examination.

The bill now explicitly applies time and distance standards to those 'imposed under a contract' in addition to those set by statute. This language is added throughout multiple provisions, broadening the bill's reach to cover contractual access requirements as well.