On Wednesday, the California Department of Managed Health Care is scheduled to roll out new regulations that limit HMO members' wait times for an appointment with a physician or specialist, the Los Angeles Times reports.
The rules stem from a 2002 state law that called for HMOs to provide faster access to medical care. Since the initial passage of the law, DMHC has been in negotiations with health plans, hospitals, physician groups and others to work out details of the regulations.
Officials say California will be the first state to limit wait times for HMO members. About 21 million state residents are enrolled in HMO plans.
Regulation Details
The new rules give HMO members the right to:
- Have access to a health care professional at all times;
- Obtain an appointment for urgent care within 48 hours of a request;
- Receive a response from a physician's office within 30 minutes of a phone call;
- See a physician within 10 business days of an appointment request; and
- Visit a specialist within 15 business days of an appointment request.
The regulations also include wait time requirements for HMOs that offer dental, mental health, vision care and other services.
Consumers enrolled in non-HMO plans will not be directly affected by the new rules.
Compliance Details
HMOs will need to submit plans for meeting the requirements within nine months and will need to comply with the new rules within one year.
After January 2011, DMHC will have the authority to penalize non-compliant HMOs.
Consumers also will be able to notify the department about delays in HMO care (Helfand, Los Angeles Times, 1/19).