Wednesday, January 20, 2010


The Doctor Will See You Now!

New rules make California first state in the nation to shorten the waiting time for an appointment

(Los Angeles) – The California Department of Managed Health Care (DMHC) has announced that California has become the first state in the nation to shorten the time a patient has to wait to see a doctor. The “Timely Access” regulations will make a significant difference for approximately 21 million California health plan members by specifying that appointments must be scheduled within certain time frames.

“California patients are literally sick of having to wait weeks to see a doctor,” said Cindy Ehnes, Director of the DMHC. “What good is health coverage if a patient can’t find a doctor taking new patients or within driving distance? These new rules say that patients can reasonably expect to have timely access to needed health care.”

Getting appointments quickly has been a common complaint at the DMHC’s Help Center, which handles consumer complaints about health plans. A 2009 study found that in Los Angeles, new PPO and HMO patients wait an average of 59 days to see a family practice physician.

Examples of the new standards include:

  • 48 hours for urgent care appointments that do not require prior authorization
  • 96 hours for urgent care appointments requiring prior authorization (including specialists)
  • 10 business days for non-urgent primary care appointments
  • 15 business days for non-urgent appointments with specialists
  • 10 business days for non-urgent appointments with a mental health care provider

The new rules were announced at a media event at Cedars-Sinai Medical Center, which already meets the time standards set forth in the DMHC regulation. The event was attended by consumer groups and health care organizations which were involved in developing the final standards.

“Care delayed is often care denied, leading to worse health outcomes or unnecessary visits to the emergency room,” said Anthony Wright, Executive Director of Health Access California, the statewide health care consumer advocacy coalition, and the sponsor of the original 2002 law. “These new first-in-the-nation rules will provide consumers with clear expectations about how quickly they should get in to see a doctor or specialist.”

Compliance with the new rules place the burden of compliance on the health plan, not the doctor. A health plan must have contracts with a sufficient number of doctors in each geographic area to serve its members. This means that plans must have a strong and varied provider network to ensure that appointments can be made within the specified timeframes.

Each health plan must submit a proposal to the DMHC for complying with the required time standards, receive approval, and begin using the standards within one year of the effective date of the regulation. While these regulations set time standards, it also provides doctors flexibility in scheduling appointments, as long as doing so would not adversely affect the patient’s condition.

Governor Schwarznegger also issued a statement applauding the new regulations.

The California Department of Managed Health Care is the only stand-alone HMO watchdog agency in the nation, touching the lives of more than 21 million enrollees. The DMHC has assisted more than 1 million Californians resolve their HMO problems through its multi-lingual Help Center, educates consumers on health care rights and responsibilities, and works closely with HMO plans to ensure a solvent and stable managed health care system.