§ 53853. Accessibility of Services.

(a) Each plan in a designated region shall retain sufficient professional medical staff, including adequate numbers of specialists and subspecialists, to provide access to preventive and managed health care services to its members. Access to physicians or physician extenders shall be as follows:

(1) Each plan shall ensure its provider network satisfies a ratio of at least one full-time equivalent primary care physician for every 2,000 members.

(2) Each plan shall ensure its provider network satisfies a ratio of at least one full-time equivalent physician for every 1,200 plan members.

(3) Plans that utilize nonphysician medical practitioners shall not allow a full-time equivalent nonphysician medical practitioner to maintain a caseload of more than 1,000 plan members. The plan shall ensure compliance with title 22, CCR, sections 51240 and 51241.

(4) If utilized by a plan, members may select a nonphysician practitioner as their primary care provider. Nonphysician practitioners including certified nurse midwives, nurse practitioners and physicians assistants, shall meet the requirements of existing practice and licensure standards for mid-level practitioners, as specified in section 1399.541 and 1470, Title 16, CCR.

(b) Each plan in a region shall ensure that each member of the plan has a primary care physician to supervise and coordinate each member's health care, by either allowing members to select their primary care physicians or assigning members to primary care physicians, pursuant to section 53890.

(c) Each plan shall ensure that members have 24-hour access to interpreter services.

(d) Each plan shall ensure that other appropriate linguistic services are available to members pursuant to the contract between the plan and the department.

HISTORY

1. New section filed 7-1-96 as an emergency; operative 7-1-96. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 96, No. 28).

2. Repealer of section and Note and new section and Note filed 3-4-97; operative 3-4-97. Submitted to OAL for printing only pursuant to Section 147, SB 485 (Ch. 722/92) (Register 97, No. 10).

Note

Note: Authority cited: Sections 10725, 14105, 14124.5 and 14312, Welfare and Institutions Code. Reference: Sections 14087.3 and 14087.4, Welfare and Institutions Code.