California Timely Access

California Timely Access

The Timely Access regulations became effective seven years ago in January 2010. Under California law, health plans are required to make sure that consumers have ready access to all services covered under their health plan contract. For this to occur, consumers must be able to see their health plan doctor and other plan providers within a timeframe that is appropriate, based on the consumer’s clinical condition. To ensure access to care, health plans must maintain networks with providers who have enough appointment availability to meet the needs of all plan members. To ensure that these appointment timeframes are met on a consistent basis, each health plan must monitor its own network, measure appointment availability and submit compliance reports to the California Department of Managed Health Care (DMHC) each year.

Timely Access Compliance Reports submitted by California health plans during the first four years of the process (2011-2014) were not useful in determining individual health plan compliance or comparing plans across the industry, due to variation in the techniques or methods used by different health plans when gathering data and measuring compliance. In 2015, following a change to the law, the DMHC created a mandatory methodology that all health plans are required to follow when gathering data, measuring compliance and submitting annual reports.

Annual compliance reports submitted by health plans include two primary categories of information: The plan’s Compliance Report, which reports performance under time-elapsed appointment availability standards; and the plan’s Provider Roster, which lists all providers who were in the plan’s network as of December 31 of the prior calendar year.

The DMHC requires that all health plans retain an audit firm to provide an External Vendor Validation report outlining the results of the required validations. In general, areas that Attest will review include (but not limited to) ensuring that the required Provider Contact List, Raw Data Template and Results Templates are used and that the health plan reported survey results for all provider types that were required to be surveyed and reported, as applicable. Attest will also validate each of the validation steps listed in the DMHC Checklist for Vendor Agreements.

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