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 |Add To My Favorites |Track Bill | Version: 10/06/25 - Chaptered
 09/13/25 - Enrolled
 09/04/25 - Amended Assembly
 07/09/25 - Amended Assembly
 05/23/25 - Amended Senate
 04/10/25 - Amended Senate
 03/25/25 - Amended Senate
 02/20/25 - Introduced

 SB-530 Medi-Cal: time and distance standards.(2025-2026)

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 Date Published: 10/07/2025 02:00 PM

SB530:v92#DOCUMENTBill Start

 Senate Bill

 No. 530

 CHAPTER 418

An act to amend Sections 14197 and 14197.9 of the Welfare and Institutions Code, relating to Medi-Cal.

 [
 Approved by

 Governor
 October 06, 2025.

 Filed with

 Secretary of State
 October 06, 2025.
 ]

LEGISLATIVE COUNSEL'S DIGEST

SB 530, Richardson.
 Medi-Cal: time and distance standards.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, under fee-for-service or managed care delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law establishes, until January 1, 2026, certain time and distance and appointment time standards for specified Medi-Cal managed care covered services, consistent with federal regulations relating to network adequacy standards, to ensure that those services are available and accessible to enrollees of Medi-Cal managed care plans in a timely manner, as specified.

This bill would extend the operation of those standards to January 1, 2029. The bill would
 also require a managed care plan to ensure that each subcontractor network complies with certain appointment time standards unless already required to do so. The bill would require a plan to demonstrate to the department each subcontractor network’s compliance with time or distance and appointment time standards, as specified.

Existing law permits the department to authorize a managed care plan to use clinically appropriate video synchronous interaction, as defined, as a means of demonstrating compliance with the time or distance standards.

Under this bill, the use of telehealth providers to meet time or distance standards would not absolve the managed care
 plan of responsibility to provide a beneficiary with access, including transportation, to in-person services if the beneficiary prefers. The bill would set forth other related provisions with regard to the use of telehealth.

Existing law permits the department, upon request of a managed care plan, to authorize alternative access standards for the time or distance standards under certain conditions.

This bill
 would, effective for contract periods commencing on or after January 1, 2027, require the department to consider the sufficiency of payment rates offered by the Medi-Cal managed care plan to the provider type or for the service type when evaluating requests for the utilization of alternative access standards.

The bill would require a Medi-Cal managed care plan that does not meet time or distance standards without
 the use of an alternative access standards request to submit to the department documentation demonstrating efforts to contract with providers, as specified. The bill would require a Medi-Cal managed care plan, effective no sooner than contract periods commencing on or after January 1, 2026, to inform enrollees of their option to use or not use telehealth, covered transportation services, or out-of-network providers to access covered services if the health care provider is located outside of the time or distance standards.

Existing law requires the department to annually evaluate a managed care plan’s compliance with the time or distance and appointment time standards and to annually publish a report of its findings, as specified.

This bill would require, effective for contract periods commencing on or after January 1, 2029, the evaluation by the department for appointment time standards compliance to be performed using a direct testing method, as specified.

The bill would authorize the department to require enhanced time or distance standards that are more stringent than the time or distance standards described above in its contracts with Medi-Cal managed care plans. The bill would require the department to ensure that these enhanced standards are consistent
 across contracts for similar geographic class