(a)

(1) A Medi-Cal managed care plan that has received approval from the department to utilize an alternative access standard pursuant to subdivision (

f) of

Section 14197, upon the request of an enrollee who is required to travel farther than the time or distance standards, as established in subdivision (

c) of

Section 14197, shall assist that enrollee in obtaining an appointment with an appropriate specialist provider within the time or distance standards established pursuant to subdivision (

c) of

Section and the appointment time standards established pursuant to subdivision (

d) of

Section 14197.

(2) For purposes of complying with the requirement to assist an enrollee, as specified in paragraph (1), a Medi-Cal managed care plan shall do either of the following: (

A) Make its best effort to establish a member-specific case agreement, at the Medi-Cal fee-for-service rate or a rate mutually agreed upon by the specialist provider and the plan, with an appropriate specialist provider within the time or distance standards established pursuant to subdivision (

c) of

Section and the appointment time standards established pursuant to subdivision (

d) of

Section 14197. (

B) Arrange for an appointment with a network specialist provider within the time or distance standards established pursuant to subdivision (

c) of

Section 14197, and the appointment time standards established pursuant to subdivision (

d) of

Section 14197.

(3) The requirements of paragraph (1) shall not apply if there is not a specialist provider with an office location within the applicable time or distance standards in relation to the area within which the enrollee resides or the Medi-Cal managed care plan has attempted to establish a member-specific case agreement with the specialist provider for any enrollee pursuant to subparagraph (

A) of paragraph (2) in the most recent fiscal year and the provider refused to enter into a member-specific case agreement. (

b) If a specialist provider is unavailable to render necessary health care services pursuant to subdivision (

a) to an enrollee within the time or distance standards established pursuant to subdivision (

c) of

Section and the appointment time standards established pursuant to subdivision (

d) of

Section 14197, as specified in subdivision (a), the Medi-Cal managed care plan or the Medi-Cal fee-for-service program, as determined appropriate by the department, shall arrange for Medi-Cal covered transportation for an enrollee to obtain covered Medi-Cal services pursuant to

Section 14132. (

c) A Medi-Cal managed care plan that has received approval from the department to utilize an alternative access standard pursuant to subdivision (

f) of

Section shall inform its affected members of the approved alternative access standards in a manner and timeframe, as determined by the department. (d) (1) “Medi-Cal managed care plan” means any individual, organization, or entity that enters into a contract with the department to provide services to enrolled Medi-Cal beneficiaries pursuant to any of the following: (

A) Article 2.7 (commencing with

Section 14087.3), including dental managed care programs developed pursuant to

Section 14087.46. (

B) Article 2.8 (commencing with

Section 14087.5). (

C) Article 2.81 (commencing with

Section 14087.96). (

D) Article 2.82 (commencing with

Section 14087.98). (

E) Article 2.91 (commencing with

Section 14089). (

F) Chapter 8 (commencing with

Section 14200), including dental managed care plans. (

G) Chapter 8.9 (commencing with

Section 14700). (

H) A county Drug Medi-Cal organized delivery system authorized under the California Medi-Cal Demonstration pursuant to

Article 5.5 (commencing with

Section 14184) or a successor demonstration or waiver, as applicable. (2) “Specialist provider” has the same meaning as “specialist” as defined in paragraph (2) of subdivision (

i) of

Section 14197.