Cal. Code Regs. Tit. 22, § 53911.5 - Accessibility to Physicians and Dentists

(a) Each GMC plan that is a PHP or PCCM plan shall retain sufficient professional medical staff to provide access to preventive and managed health care services to its members. Access to physicians shall be as follows:

(1) Each PHP and PCCM plan shall provide at least one full-time equivalent primary care physician for every 2,000 patients, or have in place an alternative mechanism for ensuring access, approved in writing by the department.

(2) Each PHP and PCCM plan shall provide at least one full-time equivalent physician for every 1,200 plan members, or have in place an alternative mechanism for ensuring access, approved in writing by the department.

(3) If utilized by a PHP or PCCM plan, mid-level practitioners, such as nurse practitioners and physicians assistants, shall meet the requirements of existing practice and licensure standards for mid-level practitioners, as specified in Sections 1399.541 and 1470, Title 16, CCR, including physician supervision, as specified in Section 2746.5, Business and Professions Code.

(b) Each dental plan shall establish and implement a mechanism for ensuring access, including but not limited to a maximum ratio of dentists to patients, approved in writing by the department.

(c) Each GMC plan shall ensure that each member of the plan has a primary care provider to supervise and coordinate each member's health care, by either allowing members to select their primary care providers or assigning members to primary care providers, pursuant to Section 53925.

Notes

Cal. Code Regs. Tit. 22, § 53911.5

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).

Note: Authority cited: Sections 10725, 14089.7, 14105, 14124.5, 14203 and 14312, Welfare and Institutions Code. Reference: Sections 14089, Welfare and Institutions Code; and Section 2746.5, Business and Professions Code.

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).