[California] Access to care standards

REQUIREMENTS: - By March 13, 2026 (or immediately if past this date): All clinical and scheduling staff must complete the mandatory Timely Access Course, including the survey at the end. Print and post the Timely Access Flier in the front office. - Scheduling team must ensure compliance with appointment access standards: schedule urgent (sick) appointments within 48 hours (or 96 hours if authorization required), routine primary care within 10 business days, specialty referrals within 15 business days, and mental health follow-ups within 10 business days. - Front desk and scheduling staff must document and track all appointment requests to ensure compliance with the specified timeframes (which include weekends and holidays). - Verify that after-hours answering service or answering machine messages include: (1) emergency instructions directing members to call 911 or go to nearest ER, (2) alternative contact number to reach PCP or on-call provider, and (3) language-appropriate messages for non-English-speaking members. - Ensure after-hours personnel answer the Anthem After Hours Survey questions and confirm members receive callback within 30 minutes for urgent non-emergency matters. - Confirm phone lines do not place members on hold longer than 10 minutes and that members seen for appointments are seen within 15 minutes of scheduled time. - Leave some appointments open each day for urgent matters and consider using telehealth to meet timely access standards. - Update Anthem immediately with any demographic changes for providers to ensure accurate network listings. - For Los Angeles County providers only: implement policy to call and reschedule missed appointments within 48 hours; may be subject to random survey compliance checks. - Billing/administrative staff should understand that delegated network care providers are measured at 70% compliance threshold for urgent/nonurgent appointments and 80% for mental health follow-ups; failure to meet these thresholds will trigger corrective action or contract termination. - Consequences of noncompliance: Corrective Action Plans (CAPs), escalated contractual sanctions, contract termination, and potential decredentialing from the Anthem network.