California physicians and managed care plans are gearing up to comply with new state regulations limiting the amount of time HMO patients must wait for physician appointments, the Ventura County Star reports.
New Rules
Last month, the California Department of Managed Health Care rolled out new rules giving HMO patients the right to obtain:
- A physician appointment within 10 business days of a request;
- A specialist appointment within 15 business days of a request;
- An urgent care visit within 48 hours of a request; and
- A telephone consultation within 30 minutes.
Most preventive care appointments and routine physicals will not be subject to the new rules.
Physicians also can waive the rules if they provide a medical explanation for why an extended wait time will not affect a patient’s health.
The rules are scheduled to take effect in January 2011.
Possible Changes in the Works
Observers predict that some HMOs will need to expand their physician networks in order to comply with the new rules.
Others say physicians and medical professionals might start using the Internet more often to communicate with patients.
Anthony Wright of Health Access predicted that insurance companies might start holding physicians more accountable for wait times because the state plans to audit insurers’ performance and possibly issue fines (Kisken, Ventura County Star, 2/5).