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SACRAMENTO, Calif.—Seven years after the enactment of legislation (A.B. 2179) directing it to do so, the California Department of Managed Health Care (DMHC) announced Jan. 20 it adopted regulations aimed at ensuring plan enrollees have timely access to health care services.
According to DMHC Director Cindy Ehnes, the new rules make California the first state to shorten the time a patient has to wait to see a doctor by requiring that managed care plans ensure member appointments with medical providers be scheduled within certain time frames. “California patients are literally sick of having to wait weeks to see a doctor,” Ehnes said in a Jan. 20 statement. DMHC said it receives complaints from managed care plan members having difficulty getting appointments with doctors, noting a 2009 study found that new patients in preferred provider organizations and health maintenance organizations wait an average of 59 days to see a family practice physician in Los Angeles. The adoption of the rules follows multiple rounds of public comment from managed care plans, providers, and consumers through most of last year. The state's Office of Administrative Law (OAL), which oversees regulatory agency rulemaking, rejected a previous version of the regulations issued Jan. 9, 2009, on the grounds that it provided too little time for public comment.
In March 2008, OAL also disapproved an earlier set of proposed rules after OAL concluded that by allowing plans to develop their own standards for patient wait times, they failed to comply with California administrative law requiring regulations to set uniform standard governing all plans.
The regulations require managed care plans meet the following appointment scheduling time frames:
However, the regulations permit these time frames to be extended if a provider has determined a longer waiting time will not have a detrimental impact on the health of the patient. The rules also contain an exception for non-urgent services including preventive care and periodic follow-up care.Plans must also provide 24/7 triage or screening services by telephone with wait times not exceeding 30 minutes.
Telephone triage or screening services can be provided through plan-operated telephonic triage or medical advice services, the plan's contracted primary care and mental health care provider network, or other means.