California Gears Up To Implement New Rules on Medical Wait Times
State officials are gearing up to implement new rules regulating how long it should take patients in California to receive medical care, the Ventura County Star reports.
The rules take effect Jan. 17.
The regulations, which are the first of their kind in the U.S., were announced one year ago.
The rules resulted from seven years of negotiations between state officials, medical groups and patient advocates.
The new regulations primarily target California residents covered by HMOs, as well as those covered by PPOs fromÂ Anthem Blue Cross and Blue Shield of California.
The rules note that maximum wait times are:
- 48 hours to see a physician for most urgent care situations;
- 96 hours for urgent care that requires prior authorization;
- 10 business days for regular primary care visits;
- 10 business days to see a mental health specialist; and
- 15 business days to see a specialist.
In addition, the rules call for health plans to establish a triage system to respond to phone calls from patients within 30 minutes, regardless of when the call is made.
California's Department of Managed Health Care will administer the regulations. For the first year, officials will focus on ensuring that the rules are implemented statewide. Health plans that repeatedly fail to meet the wait time requirements eventually could face fines and penalties.
Cindy Ehnes, director of DMHC, said insurers will be held responsible for compliance with the rules. She added that she expects health plans to expand their physician networks in some regions to meet the new requirements.
According to Ehnes, physician offices can waive the requirements in certain cases if they provide medical justifications for delays in care (Kisken, Ventura County Star, 1/4).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.