When patients receive the right care at the right time, it can result in better health outcomes and an improved care experience.

The State of California has set forth regulations to help ensure individuals with health maintenance organization (HMO) plans receive timely access to medical and behavioral care based on their needs. Timely appointment access is also required as part of your Cigna Healthcare contract.

Annual Provider Appointment Availability Survey

Based on Knox-Keene regulations, the Department of Managed Health Care (DMHC) developed the Provider Appointment Availability Survey (PAAS) to measure access to care for California HMO plan enrollees. All reporting health plans are required to adhere to the DMHC’s specific methodology when administering the PAAS and reporting compliance rates for timely appointment access. 

Each year, we require randomly selected Cigna Healthcare network-participating providers to complete the PAAS to help ensure compliance with the California regulations and Cigna Healthcare access standards for care.

Resources

Please refer to the infographic on this page, which we encourage you to use as a visual reminder of appointment standards for your patients based on their needs.

To learn more about California access standards, refer to the resources below.

• Cigna Healthcare Reference Guide: California (Log in to the Cigna for Health Care Professionals website > Resources > Reference Guides > Medical Reference Guides > Health Care Professional Reference Guides > California)
• California DMHC website 

Questions? We’re here to help.

Please contact your Cigna Healthcare Provider Relations representative or email at Access2Care@Cigna.com.

Image courtesy of California Department of Managed Health Care (DMHC). (2024). Timely Access to Care Fact Sheet. [Digital Image]. Retrieved from https://www.dmhc.ca.gov/Portals/0/Docs/DO/TAC_accessible.pdf. Please do not redistribute without permission from the DMHC.

1  Examples of non-physician mental health providers include counseling professionals, substance abuse professionals, and qualified autism service providers.

2  Examples of ancillary services include lab work or diagnostic testing, such as mammogram or MRI, or treatment such as physical therapy.