The waiting game…

Friday, March 9th, 2007

* Lack of timely medical appointments a major consumer complaint & health obstacle
* Health plans and providers testify that providing timely appointments “very burdensome”
* Need for strong and clear time-elapsed standards debated
* False “choice” posed, between timely access and linguistic access to health care

The Department of Managed Health Care (DMHC) held a hearing on this past Monday, March 5, 2007 in Sacramento to seek public comment on their proposed new regulation governing timely access to care.

This long-delayed regulation is based on AB2179(Cohn) sponsored by Health Access and passed in 2002. For the last thirty years, since the Knox-Keene Act was passed in 1975, HMOs have been required to provide timely access to care and have filed their own self-imposed standards saying that patients should be able to see doctor within so many days, etc. And for decades neither the HMOs nor the department in charge of overseeing them bothered to check if consumers got care when they needed it. So five years ago, the Legislature acted to required specific, uniform and enforceable standards for timely access to care.

The regulations to implement the law are not just a boon for patients seeking to get a phone call answered, or get an appointment quickly. They are also seen as a way to gauge netowrk adequacy, to ensure that an insurer has enough doctors and specialists in their network. FInally, such regulations are expected to have a positive impact on the issues of emergency room overcrowding and rising health care costs: many Californians now wind up in the emergency rooms with worse conditions because they are unable to get a timely appointment with a provider, in what is a more appropriate and less costly setting.

INDUSTRY OPPOSITION: The health plans, providers, and their associations all spoke against the Department’s regulation as written. They expressed their clear dislike for time-elapsed standards. DMHC wrote these regulations to require that consumers must be able to see a physician within certain prescribed time frames. Some examples of the time frames specified in the regulation require that consumers:
* see a primary care physician for urgent care within 24 hours,
* get an appointment for routine care with a primary care physician within 10 days, or
* be referred to a specialist for urgent care within 72 hours.

The provider community emphasized that this would result in “chaos in the delivery of health care in California ” and would be “very burdensome to administer.” One executive testified that she had “no difficulty getting a prompt appointment with her doctor.” One plan representative asserted that the Department should put forward a very minimal regulation because “nothing they would do would improve the timeliness of access to care” rather than the “rigid” standards currently proposed.

CONSUMER GROUP SUPPORT: Consumer advocates, from Health Access California, Western Center on Law and Poverty, and Health Care Rights Hotline, countered these claims at the hearing. They emphasized that this law was passed five years ago and, because of the delay in drafting the regulation, plans and providers had plenty of time to prepare for their implementation. They argued that the best way to measure that consumers were afforded timely access to care was to measure how long it took to get a necessary health care appointment. Advocates urged that it was now time to move forward and were generally supportive of the regulation as written.

But plans also expressed surprise that time-elapsed standards were being imposed because the law does allow for some alternative standards. However, in the five years since passage of the law, the plans and providers had not experimented with other ways to gauge if timely access to care is being delivered, nor have they developed any alternative way to assess if appointments are being offered on a timely basis.

REPORTING: Health plans and providers also expressed objections to any monitoring by the plans or the Department of this regulation. They stated the regulation would lead to higher administrative costs, claiming that the rules would require extensive record-keeping, including tracking every phone call received at the expense of actually providing care. Consumer advocates refuted such statements, and suggested several mechanisms for cost-effective monitoring of this regulation to ensure compliance. Theu argued the regulations allowed for flexibility for the plans without requiring burdensome record-keeping. They also proposed that the ability to provide timely access to care beyond these standards could even be an important way for consumers to differentiate between providers and/or plans in making health care choices.

EXEMPTION FOR LANGUAGE ACCESS?: The Department raised one disturbing question during the course of the hearing. DMHC asked several testifiers if it would be acceptable for consumers if they had to forego any entitlement to timely access to care if they required language assistance. This is especially troublesome since the Department finalized their Cultural and Linguistic Access to Care regulation on February 23, 2007. This landmark regulation guaranteed low English proficient consumers the right to have health care delivered in a language they understood and written documents provided in multiple languages. Consumer advocates resoundingly affirmed at the hearing that consumers should not be required to make a “choice” between receiving health care in a language they understood and receiving health care on a timely basis (nor should providers be permitted to make that choice for their patients.) The impact of being forced to make such a decision would be clearly discriminatory.

ACTION: Consumer advocates are awaiting the Department’s decision whether to make the regulation final as written or to invite another round of comments. All interested parties should check the Department’s website at for announcements regarding the finalization of the regulation or the scheduling of another public hearing on timely access to care. If DMHC undertakes a revision of the regulation, consumer advocates should be prepared to testify and/or provide written comments against the weakening of the proposed standards.

Questions and requests for more information should be referred to Elizabeth Abbott, Project Director, Health Access, at (916) 497-0923, ext. 201, or by email to

Health Access California promotes quality, affordable health care for all Californians.
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