California regulators have set plans to kick off long-awaited rules which will set standards for how quickly HMO patients must be seen by physicians, as well as setting standards for how promptly medical offices respond to requests. California says it is the first state to set such time standards for HMOs, which serve almost 21 million state residents.
The new rules, from the California Department of Managed Health Care, will require that HMO patients be given appointments within 10 days of requesting one. Specialists will have 15 days to provide an appointment. Meanwhile, patients needing urgent care that don't require prior authorization will have to be seen within 48 hours.
What's more, doctors' offices will have to return telephone calls within 30 minutes, and make themselves available 24 hours a day.
Such rules have been under discussion since the DMHC implemented a 2002 rule requiring more timely access to medical care. However, it has taken a full seven years to negotiate an agreement acceptable to the wide range of stakeholders involved, including HMOs, doctors, hospitals and consumer groups.
To find out more about the new rules:
- read this Los Angeles Times piece
Related Articles:
Calif. bill gives state extra power to fine insurers who don't pay providers
Calif. agency sues Prime Healthcare for balance-billing insured patients
Calif. regulators begin broad review of policy cancellations