Alliance Alternative Access Standards

The Department of Health Care Services (DHCS) provides health plans with guidelines on time and distance standards for members to access health care services. These standards are to ensure that providers of certain health care services are located within a certain number of miles or travel time from where members live. All health plans are required to meet these standards or have an established Alternative Access Standard (AAS) approved by DHCS.


Time and Distance Standards for Primary Care Providers (PCP), Specialists and Hospitals:


Provider Type Time and Distance Standard
Primary Care
(adult and pediatric)
10 miles and 30 minutes from the member’s residence
Specialty Care
(adult and pediatric)
Based on county population density

Santa Cruz County
30 miles and 60 minutes from the member’s residence

Merced and Monterey Counties
45 miles and 75 minutes from the member’s residence
Hospital 15 miles and 30 minutes from the member’s residence

The list below is the time and distance standards by zip code and the provider types for which the Alliance has received DHCS approval. If you need to access care to a provider that is located far from where you live, you can call Member Services for help. They will work with you in finding a provider that is close to where you live. You can also request to arrange transportation for you if the Alliance cannot find care near you, even if that provider is located far. The Alliance considers far if you cannot get to that provider within the Alliance’s travel time and distance standards for your county, regardless of any Alternative Access Standard the Alliance may use for your ZIP Code. The Alliance can also arrange care for you with a closer provider who is not part of the Alliance provider network.


Call Member Services at 800-700-3874 (TTY: Dial 711). We are here Monday through Friday, 8:00 am - 5:00 pm.



Citations

Welfare and Institutions Code section 14197.04(c)
Revised Final Network Adequacy Standards (March 26, 2018)
Policy # 300-7030-Reimbursement Non-Contracted Providers
Policy # 200-2010 Non-Medical Transportation
Member Handbook Evidence of Coverage (EOC) and Disclosure Form


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