Are You Ready for the New State Requirements for Scheduling Patient Appointments?

The California Department of Managed Care (DMHC) has announced new regulations that ensure HMO patients receive timely appointments with their health care professionals.

The new rules state that HMO patients must receive the following:

• Phone Calls: Return call within 30 minutes of a phone call
• Urgent Care: Appointment date within 48 hours of a request
• Physician Appointments: Appointment date within 10 business days of a request
• Specialist Appointments: Appointment date within 15 business days of a request

The regulations also include wait time requirements for dental, mental health, vision care and other services.

The new regulations stem from a 2002 state law requiring HMOs to provide more timely access to medical care. Since the initial passage of the law, DMHC has been working with health plans, physician groups, hospitals, consumer groups and others to determine the details of the regulations. California is the first state in the nation to shorten the time an HMO patient must wait to see a doctor.

A 2009 study found that patients in Los Angeles wait 59 days on average to see a family practice physician. More than half of Los Angeles County residents receive health insurance through an HMO, or around 5 million residents.

View the complete DMHC guidelines on this topic.

Visit the DMHC Website.