Regulators Faulted for Altering State Law on HMO Guidelines

Physician groups and patient advocates are criticizing the Department of Managed Health Care for failing to comply with a state law that seeks to improve timely access to care for HMO members, the Los Angeles Times reports.

Background on Law

Under a 2002 law, California regulators were required by 2004 to "develop and adopt regulations to ensure that (HMO) enrollees have access to needed health care services in a timely manner."

Last summer, three years beyond the deadline, DMHC officials released draft regulations. Under the rules, HMOs would have to provide appointments for:

Diagnostic testing within 24 hours;
Urgent physical therapy within 72 hours; and
Preventive care with a specialist within 22 days.

However, after objections from HMOs and doctors groups, state regulators abandoned the rules, instead requiring health plans to establish their own sets of guidelines to comply with the state law. The health plans' guidelines are due in October, at which point the department will review them.

Criticism

Anthony Wright, director of Health Access, argued that DMHC's failure to mandate a set of uniform rules is "a betrayal of consumers and of the clear intent of the law." He criticized the department for letting insurers "set their own standards."

Physicians groups that contract with HMOs also oppose the state's decision, arguing that it allows health plans to micromanage how, when and for how long doctors can see patients. William Barcellona, chief lobbyist for the California Association of Physician Groups, said, "This is the problem people were complaining about years ago. We've come full circle" (Rau, Los Angeles Times, 2/5).

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