The Department of Managed Health Care (DMHC) recently proposed regulations that would require physicians to see patients covered by DMHC-regulated health plans within certain prescribed time frames. The regulations would, among other things, require a primary care physician to see patients with urgent health care needs within 24 hours, to see those with routine health care needs within eight business days, or to refer patients to specialists for urgent care within 72 hours.
CMA is concerned that the proposed regulations are inconsistent with the legislative intent of the Knox-Keene Act. In passing the act in 1975, the Legislature found that “lack of timely access to health care may be an indicator of other systemic problems such as lack of adequate provider panels, fiscal distress of a health care service plan or health care provider, or shifts in the health needs of a covered population.”
The Knox-Keene Act already contains numerous requirements for patient access. “Enforcement of these laws is the first step toward achieving access to care by ensuring that sufficient numbers of physicians are able and willing to participate with health plans so that patients can obtain medically necessary services,” wrote CMA’s Aileen E. Wetzel in comments submitted to DMHC last week.
CMA urged DMHC to focus its efforts on collecting detailed information from health plans to ensure that they have adequate networks of contracting providers, instead of implementing burdensome regulations.
