A timely bonus on timely access...

Posted on 23 December 2009

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By Beth Capell

An end of the year bonus—and one that we really earned!

On Friday, December 18, 2009, Health Access received word that the timely access regulations will be final effective January 17, 2010.

We have worked on this issue for more than a decade. The original HMO Patient Bill of Rights, a package of more than twenty bills, included timely access in AB 497 (Wildman).

AB 497 was vetoed in the face of bitter opposition from the HMOs and the Wilson Administration. The legislative staff for the Department of Corporations which was responsible for regulating at that time told us that whatever an HMO decided was timely access was the standard. That was not nearly good enough for Health Access.

AB 497 set specific standards for timely access, standards that are remarkably similar to those that are now in effect. AB 497 required that:

* A telephone call be answered within four minutes
* A non-urgent appointment be provided within ten days
* A medically urgent appointment be provided within 48 hours

And what do we have in the regulations just finalized?

* A physician, registered nurse or other appropriately licensed health care professional must provide telephone triage within 30 minutes
* A non-urgent appointment must be provided within ten days
* An urgent appointment must be provided within 48 hours
Plus a variety of other standards for mental health services and dental care.

Well, maybe four minutes was a bit of a stretch but the notion that every consumer can get triage in time to get to an emergency room within the so-called golden hour, if needed, is now part of the requirements for all physicians who contract with DMHC plans, which is virtually every practicing doctor in California.

Timely access was not part of the package of legislation adopted in 1999 that we usually refer to as the HMO Patient Bill of Rights. Instead, timely access (AB 2179 Cohn) and language access (SB 853 Escutia) were adopted later along with standards of prescription drug coverage (SB 842 Speier), all enacted in 2002 or 2003.

And the strategy for both timely access and language access was the same: the law required the DMHC to adopt regulations that specify how HMOs and PPOs would meet the obligation to provide care in a timely manner and in the language spoken.

Language access regulations were completed prior to those for timely access but the timely access regulation ties down one key piece of language access: that the requirements for interpretive services run concurrent with the timely access requirement—that is, when you show up for the doctor’s appointment within ten days, they should be prepared to provide care in the language you speak.

We have worked on this issue for more than a dozen years. The enactment of the regulations are a major milestone. But our work is not done—now we will look to see whether HMOs and providers comply and how vigorously the regulations are enforced.


Beth Capell provides policy analysis, legislative advocacy, and other strategic input to Health Access and to other consumer, labor and public interest organizations on health care issues. This article first appeared in Health Access Blog

So with a shortage of physicians, we are going to force docs to see everyone ASAP. Be assured that the patient protection laws will simply be added to all physician HMO contracts with termination penalties.

You have a shortage of docs in CA... let's make the hamsters turn the wheel faster... until they wise up and quit the HMO panel altogether.

Stupid legislation. How about paying docs better or helping them make a better living by reducing their costs. Maybe you could recruit a few more docs to Cali.

I personally have passed on several jobs in Cali. The pay is poor, regulation oppressive, and cost of living out of sight. Good Luck.