Cal. Code Regs. Tit. 22, § 53890 - Assignment of Primary Care Physician

(a) Each plan in a designated region shall have a mechanism in place and approved in writing by the department to ensure that each member is assigned to a primary care physician, by either:

(1) Allowing each member to select a primary care physician from the plan's network of affiliated physicians, if the member chooses to do so; or

(2) Assigning a primary care physician to each member within forty days from the effective date of enrollment, if the member does not select one within the first thirty days of the effective date of enrollment in the plan. This assignment shall meet the conditions of both:

(A) The member shall be assigned to a primary care physician within the maximum travel distances specified in section 53885.

(B) The member shall be assigned to a primary care physician who is or has office staff who are linguistically and culturally competent to communicate with the member or have the ability to interpret in the provision of health care services and related activities during the member's office visits or contacts, if the language or cultural needs of the member are known to the plan.

(b) The plan shall provide the member written notice of their assignment to a primary care physician within 10 days of their assignment, and informing the member of their right to choose another primary care physician from the plan's list of approved primary care physicians.

(c) Any member dissatisfied with the primary care physician selected or assigned shall be allowed to select or be assigned to another primary care physician. Each plan shall assist its members in changing primary care physicians if that change is requested by the member. Any request by a member to change primary care physicians shall be processed by the plan within 30 days of the date the request is received by the plan.

(d) Any plan physician dissatisfied with the physician/patient relationship with any member may request that the member select or be assigned to another primary care provider.

Notes

Cal. Code Regs. Tit. 22, § 53890

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 heading, section and NOTE and new section heading, 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.

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 heading, section and Note and new section heading, 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).