California is poised to become the first state to set time limits for doctors to see patients, the Department of Managed Health Care said.
Regulations to be announced Wednesday require family practitioners in health maintenance organizations to see patients seeking an appointment within 10 business days. The deadline for specialists is 15 days.
A patient seeking urgent care that does not require prior authorization must see a doctor within 48 hours.
However, doctors can extend the waiting period if they determine it will not harm the patient's health.
The rules, set to take effect in January 2011, "set reasonable expectations about when care should be provided," Department of Managed Health Care Director Cindy Ehnes said.
The regulations follow years of negotiations between state officials, doctors, hospitals, HMOs and consumer and health care activists. A 2002 state law mandated more timely access to medical care but didn't provide specifics.
The rules could be an important change for the 21 million Californians who subscribe to HMO plans, state officials said.
"These regulations ... will not only get people access to care when they need it but will reduce unnecessary use of the emergency room," Anthony Wright, executive director of the consumer group Health Access California, told the Los Angeles Times.
With California facing a shortage of doctors, some physicians said HMOs will only be able to comply with the new deadlines if they hire more medical staff.
"A regulation like this will certainly add another challenge," said Charles Bacchi, executive vice president of the HMO trade group California Association of Health Plans.
Kaiser Permanente, the nation's largest nonprofit HMO, should be able to comply with the new regulations, said Patti Harvey, vice president for quality in Southern California. She declined to estimate potential costs.
