HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Tuesday, January 19, 2010

California Caps Patient Wait Times for HMOs

California regulators are implementing new rules that limit the long waits that many people endure to see a doctor when they are members of health maintenance organizations. The LA Times reports that  

[t]he regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15.

Patients seeking urgent care that does not require prior authorization must be seen within 48 hours. Telephone calls to doctors' offices will have to be returned within 30 minutes, and physicians or other health professionals will have to be available 24 hours a day.

California says it is the first state to set time standards for HMOs, which serve nearly 21 million of its residents. The managed healthcare department acted in response to a 2002 law that mandated more timely access to medical care. The law left it to state officials to work out the details, which became subject to protracted negotiations with HMOs, doctors, hospitals, consumer groups and other healthcare activists.

In all, it took seven years to finally reach agreement amid intensive talks, bureaucratic hurdles and a lengthy rule-writing process, participants said.

After the rules are unveiled Wednesday, HMOs will be given nine months to submit plans that meet the new guidelines, allowing for the fact that many HMOs will need to revise their contract agreements with physician networks and other groups.

HMOs will be given until January 2011 to comply; after that, the managed healthcare department will have the authority to penalize HMOs that fail to ensure timely care. People will be able to complain to the department about delays.

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