An Opportunity to Get Better Timely Access to Care Regulations in California

March 5, 2007: DMHC holds its first public hearing on its first set of proposed regulations. The 14-page regulations (among many other things) spells out exactly how quickly patients should be able to get in to see a doctor in certain situations. (I.E. Urgent primary care needs: 24 hours; Routine primary care needs: 10 days; Urgent specialty care: 72 hours; Routine specialty care: 14 days).

July 15, 2007: DMHC releases second version of regulations. As in the March version, this draft also contains time-elapsed standards.

September 18, 2007: DMHC holds second public hearing on a revision of the proposed regulations and accepts comments.

December 10, 2007: DMHC's third version of these rules completely strips out all specificity. Gone are state standards requiring that a patient who needs urgent care be able to see a primary care physician within 24 hours. Instead, the new rules allow health plans to define, for themselves, what constitutes "Timely Access.'' This stripped-down draft shrinks from 28 pages to 7 pages. The Department gives interested parties 15 days to submit comments -- from Dec. 10 - 26. (Note: It's this final 15 days where DMHC gets into trouble).

January 11, 2008: DMHC submits final regulations for approval with Office of Administrative Law. (The Office of Administrative Law has 30 days to approve the regulations -- which it refused to do yesterday.)

Health Access, the sponsors of AB 2179, and consumer advocates have many substantive reasons to scream and howl about the latest draft of the regulations. We believe the state flouted the law, intended to get consumers proper health care when they need it (not weeks and months later). In doing so, we believe they lacked the "statutory authority'' to do what they did. We also believe that the Department was deliberately vague and unclear, allowing insurers to willy nilly make up their own rules.

But what hung the DMHC was its "belief" that the differences between the second and third versions were not substantial (though, anyone who is not color blind looking at all the red in the "track changes'' function could see otherwise.) The Department gave the public only 15 days to comment on the rules -- clearly not enough time for "major changes,'' which require 45 days. But the full 45 days would have meant that the Department would blow its January 11 deadline.

What OAL did this week was buy consumer advocates time to make the regulations right. That means we'll have another year -- maybe less -- to fight at the Departmental level (again) to ensure patients get care when they need it. In the meantime, Health Access will continue to keep advocates abreast of movements on Timely Access and post relevant documents. (We'll post letters, correspondence from the past year soon).

Hanh Kim Quach is the Health Care Policy Coordinator for Health Access California. Before joining the organization, she worked as a journalist for nearly 9 years covering issues in California. Health Access California is a statewide health care consumer advocacy coalition of over 200 groups. This article has also been published on the Health Access Weblog.