California access standards

California law has established appointment availability standards to ensure timely access to necessary health care services. Our members have the right to schedule an appointment within the following time frames:

Note that referrals from a Primary Care Physician (PCP) or specialist are subject to the above time-elapse standards.

Exceptions to the appointment time frames above

• The above time frames may be extended if the referring or treating provider has determined and noted in the appropriate record that a longer wait time will not have a negative impact on the member’s health.
• Preventive care services and follow-up care may be scheduled in advance as determined by the treating licensed health care provider.

Time frames for rescheduling appointments

If it is necessary for a provider or a member to reschedule an appointment, the appointment must be promptly rescheduled in a manner that is appropriate for the member’s health care needs and that ensures continuity of care consistent with good professional practice.

Time frames for NPMH and SUD follow-up appointments

Members who are undergoing a course of treatment for an ongoing mental health or substance use disorder condition must be able to schedule a follow-up appointment with the NPMH or SUD provider within 10 business days of the prior appointment.

Corrective action for not meeting time frames

The Department of Managed Health Care (DMHC) and California Department of Insurance (CDI) regulations require that Aetna® monitor its provider network and investigate and request corrective action (via a Corrective Action Plan, or CAP) if it doesn’t provide timely access to care. Therefore, we ask that you please take time to review the California appointment standards with your staff. Our goal is to work with your office to ensure that our provider networks are compliant with these California Timely Access requirements.