It’s time to take action…

Thursday, February 7th, 2008

* Recent LA Times Article Spotlights Issue; Ability to Get Timely Care at Risk
* In Implementation of AB 2179, DMHC Would Let Plans Set the Rules
* New Regs Have No Specific Standards for Consumers to Keep HMOs Accountable

* ACTION ALERT: Call or fax state officials to urge them to withdraw proposed regs, and to set strong and specific standards for timely access to care.

Click here for the Health Access WeBlog: The Next Legislative Leadership; What’s Next?; From the Ashes; ITUP Conference; New Paper on Hospital Charging; More on Timely Access

Six years after California passed a law that would guarantee patients an appointment with doctors and specialists in a reasonable timeframe, the state has pulled back on regulations that would have set explicit standards, and are on the verge instead of letting each health plan make their own rules on this important issue.

Consumer advocates, including Health Access California, were dismayed by recent regulations on timely access to care that were proposed by the Department of Managed Health Care (DMHC), the state regulatory agency that oversees health plans in California.

Airlines are not allowed to regularly overbook flights so that passengers are routinely bumped to planes in future months; But HMOs will overbook their provider networks, and without strong oversight, patients are often asked to wait weeks for urgent care, or months to see a specialist.

Care delayed is often care denied. Some patients end up with worse health conditions, while others decide they can’t wait any longer and go to the emergency room for more expensive, less efficient care.

ACTION ALERT: Call or fax state officials to urge them to withdraw the proposed regulations on “timely access,” and to put forward new rules with strong and specific standards. These regulations will affect every Californian’s ability to obtain a medical appointment, or receive a timely referral to a specialist. Contact:

* Governor Arnold Schwarzenegger, at (916) 445-2841 or fax (916) 445-4633, and
* Secretary Dale Bonner, Secretary of Business, Transportation and Housing the responsible cabinet secretary over DMHC at (916) 323-5400 or fax (916) 323-5440, and
* Director Cindy Ehnes, Director of the Department of Managed Health Care, at (888) HMO-2219 or fax (916) 255-5241.

BACKGROUND: These long-delayed regulations are supposed to implement a law passed in the California legislature in 2002 that guarantees consumers the right to see a doctor within specific times for emergencies, for routine care, or for referrals to specialists. The Office of Administrative Law is now reviewing the current proposed regulations to implement 2002’s AB2179 by Assemblywoman Rebecca Cohn, sponsored by Health Access California.

The Department has also limited the scope of these regulations by refusing to apply these rules beyond full-service health plans to specialty plans, such as dental and vision plans.

Rather than following the law that requires the Department to set specific time limits that plans must adhere to, the DMHC is proposing to allow each plan to set and enforce their own, presumably more lenient, requirements that the Department would review.

The Department has also given plans the option to set up more lax alternative timely access standards in geographic areas where plans say it is hard to recruit doctors, especially specialists, such as rural, low-income, or inner-city areas. This regulation would also permit plans to make health care professionals available to give telephone advice to consumers, but only during weekday work hours. If a consumer had what they thought was an emergency after working hours, their only option would be to leave a voicemail message with the health plan for a call back during the next working day or the following week.

Even though the goal of timely access to care has been in the Knox/Keene law regulating health plans since the 1970s, the lack of timely access to health care remains a common complaint by Californians, representing roughly 10% of the complaints that are received by some consumer health advocacy organizations who advise consumers on health care issues. Even though this law was passed six years ago, plan and providers continue to vocally object to the imposition of any measurable time-elapsed standards that the Department could enforce.

These problems were featured in a Los Angeles Times article Tuesday, which spotlights the unfulfilled promise of the legislation from 2002 that has still not been implemented.

Consumer advocates from Health Access California, Western Center on Law and Poverty, and other organizations, have pressed Cindy Ehnes, the Director of the Department of Managed Health Care, to withdraw this version of the regulations on timely access to care. Advocates pledged to participate in an expedited negotiation with the Department and the industry to come up with meaningful and enforceable timely standards that would actually ensure consumers would get timely access to their health care providers.

If you have questions or need more information, please contact the author of this alert, Elizabeth Abbott, Project Director at Health Access at, or (916) 497-0923, ext. 201.

Health Access California promotes quality, affordable health care for all Californians.
VIEW THE FILE Timely Access

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