Cal. Code Regs. Tit. 22, § 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.
Notes
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: Authority cited: Sections 10725, 14105, 14124.5 and 14312, Welfare and Institutions Code. Reference: Sections 14087.3 and 14087.4, Welfare and Institutions Code.
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).
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