As of today, California is the first state in the nation requiring HMOs to make sure their members can see their doctor within reasonable time frames.
Calif. rules on waits for doc visits take effect
The regulations, approved in 2010, specify the usual wait times for appointments. For instance, patients must be seen within 48 hours for an urgent-care appointment that doesn’t require prior authorization. Non-urgent primary-care appointments must be scheduled within 10 days of the patient request. Specialist appointments should occur no later than 15 days from the request, and patients needing mental health appointments with someone other than a physician should be seen within 10 business days. Non-urgent appointments for ancillary services for diagnosis or treatment of an injury or illness should occur within 15 business days of the request, according to the rules.
Health plans must make sure they have adequate provider networks to meet these requirements. They must also be able to respond to patient calls for appointments quickly, in most cases within 30 minutes. If timely appointments aren’t possible in certain geographic areas, then the health plan must refer enrollees to available providers in neighboring service areas.
"While these regulations are not a cure-all for what ails healthcare, they are a big step forward in improving quality of care by shortening the time a California HMO patient has to wait to see the doctor," said Cindy Ehnes, director of the California Department of Managed Health Care, which oversees HMOs, in a news release. "It’s important to note, however, that we are not putting doctors on a stopwatch. The burden of complying with the access standards is on the health plan, not the doctor."
About 21 million Californians, or about 57% of the population, are enrolled in HMOs, according to the DMHC.
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