California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 2 - Policy Forms and Other Documents
Article 6 - Provider Network Access Standards for Health Insurance
Section 2240.16 - Access Standards for Pediatric Vision and Oral Essential Health Benefits and Specialized Policies that Cover Dental Benefits Only

(a) Health insurance policies covering the pediatric vision or oral essential health benefit, as defined in subdivision (a)(4) and (a)(5), respectively, of Insurance Code section 10112.27 (regardless of whether such coverage is provided directly through the policy or through subcontracting arrangements), specialized health insurance policies that provide coverage for the pediatric oral essential health benefit (as defined in subdivision (a)(5) of Insurance Code section 10112.27), and specialized health insurance policies that cover dental benefits only (as defined in subdivision (c) of Insurance Code section 106) must assure that there are adequate full-time equivalents of network providers accepting new patients covered by the policy to accommodate anticipated enrollment growth.

(b) In addition to ensuring compliance with the clinical appropriateness standard set forth in subdivision (b)(1) of Section 2240.15, each health insurance policy covering the pediatric oral or vision essential health benefit, specialized health insurance policies that provide coverage for the pediatric oral essential health benefit (as defined in in subdivision (a)(5) of Insurance Code section 10112.27), and specialized health insurance policies that cover dental benefits only (as defined in subdivision (c) of Insurance Code section 106) shall ensure that contracted oral and vision provider networks have adequate capacity and availability of licensed health care providers, including generalist and specialist dentists, ophthalmologists, optometrists, and opticians -to offer insureds appointments for covered oral and vision services in accordance with the following requirements:

(c) The applicable waiting time for a particular appointment may be extended if the referring or treating licensed health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of the provider's practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the covered person.