With so much going on regarding the budget, it’s important not to forget and highlight the upcoming hearing and DMHC comment deadline THIS MONDAY, FEBRUARY 23rd, on the crucial issue of timely access to care, an important plank in our ongoing work on HMO Patients Bill of Rights.
After six years since the law we passed, we have a chance to win clear standards for timely access to care!
ALERT: DMHC TO HOLD FINAL HEARING
ON NEW TIMELY ACCESS TO CARE STANDARDS
* CA Department of Managed Health Care Finalizes New Regs on Timely Access to Care
* Need Public Comments to Support Time Standards to Get Primary and Specialty Care
* ACTION ALERT: Letters & DMHC Hearing Testimony Needed on Monday, Feb 23rd
After years of advocacy by consumer and health advocate, California patients are close to a major victory in winning clear standards to ensure timely access to health care from their health plan.
One of the most common complaints from consumers is that they cannot get in to see their doctor on a timely basis. These HMO regulations will put in place requirements and establish expectations for concrete, time-elapsed standards based on type of service needed and degree of medical urgency. These rules stipulate that consumers should be able to:
* See a primary care physician for urgent care in less than 48 hours,
* Consult with a specialist within 96 hours of an urgent referral,
* Obtain a non-urgent appointment for primary care within ten business days, or
* Receive advice from a health care professional 24/7 regarding whether a symptom indicates an emergency or the consumer can safely wait until regular business hours on the next workday.
* Have interpreter services coordinated with scheduled appointments.
Research shows that insured Californians often obtain medical care from emergency rooms, the most expensive place to get medical care, because they cannot get in to see their doctor on a timely basis. In many cases, care delayed is care denied, leading to worst health outcomes and more expensive treatments.
The History: Health Access first sponsored legislation in this area in 1997, when we sponsored AB497 by then-Assemblymember Scott Wildman. In 2002, AB2179, authored by Assemblymember Rebecca Cohn (D-Saratoga), passed the legislature, and was signed by Governor Davis.
Not surprisingly, HMOs and providers have fought over these years not only to delay the regulations but to make them meaningless. Health Access opposed earlier versions of the regulations that were no better than the inadequate procedures in place since 1975 when the Knox-Keene Act was created.
After numerous consumer advisory panels, stakeholders’ meetings, public hearings, informal comments, formal written comments to the Department of Managed Health Care, withdrawal and reissuance of previous versions of this regulation, we now may be close to this regulation being enacted. The proposed regulations are at the DMHC website:
Support Needed for Specific Standards: Health Access beleives that the language of the regulation, while not perfect, provides reasonable protections and specific time-elapsed standards for consumers to obtain timely access to health care. It also outlines reporting responsibilities of the plans, appeals actions available to consumers, and oversight duties to be performed by DMHC.
The Department has formally issued this regulation and they are soliciting comments on it from the public through February 23, 2009. For more information about the issue, go to recent posts on Timely Access issues on the Health Access WeBlog, at:
Consumer advocates need to act now to support these regulations. We need to make our voice heard so that consumers can get the care they need when they need it.
LETTERS/COMMENTS REQUESTED: Comments should be addressed to Department of Managed Health Care, Office of Legal Services, Attn: Regulations Coordinator, 980 9th Street , Sacramento , CA 95814 or you may comment on DMHC’s website at www.dmhc.ca.gov. Your comments should reference Timely Access to Non-Emergency Health Care Services, Control No. 2008-1579 and must be received by DMHC no later than 5:00 pm on Monday, February 23, 2009. The fax number is 916-322-3968. Contact Health Access for additional materials.
PUBLIC HEARING/ORGANIZATIONAL TESTIMONY REQUESTED: The Department will hold a public hearing THIS MONDAY, February 23rd, at 9:00am, in Sacramento, at 980 9th Street, 2nd Floor conference rooms.