California moves to limit HMO wait times

LOS ANGELES (MCT) — Seeking to reduce the long waits many people endure to see a doctor, California regulators are implementing new rules that specify how quickly patients in health maintenance organizations must be seen.

The regulations by the California Department of Managed Health Care, in the works for much of the past 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 health care 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 health care activists.

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

"It's been a long time coming," said Anthony Wright, executive director of Health Access California, a consumer group that pushed for the 2002 law. "These regulations ... will not only get people access to care when they need it, but will reduce unnecessary use of the emergency room."

The rules will be unveiled today at Cedars-Sinai Medical Center in Los Angeles and phased in over the next year.

The legislation came in response to complaints from HMO members of long delays in getting treatment, and it does not generally affect people served by other health care plans.

HMOs cautiously support the new rules, even as some predict that they may drive up costs.

Kaiser Permanente, the nation's largest nonprofit HMO, said it would spend the next two months analyzing potential gaps in the delivery of medical services to fulfill the requirements.