Office of Administrative Law Rejects DMHC’s Timely Access Regulations
[Posted 03/17/08]

The Department of Managed Health Care (DMHC) has submitted final regulations relating to timely access to health care for patients.  The goal of the regulations is to establish maximum waiting times for routine care, preventive care, urgent care, as well as referral and telephone waiting time. Although the proposed final regulations were an improvement from previous versions, CMA continues to have serious concerns with the regulations.

Most significantly, CMA is concerned that the proposed regulations fail to establish standards to ensure that health plans maintain sufficient provider networks. “A patient’s timely access to care goes hand in hand with the availability of physicians in a plan’s network; to simply address one without the other is unreasonable and unworkable,” wrote Armand Feliciano, CMA Associate Director of Medical and Regulatory Policy, in comments submitted to DMHC.

The initial draft regulations published last year proposed dozens of specific time standards, including standards for scheduling  routine and urgent care appointments, office waiting time, and timely telephone access. While CMA is pleased DMHC has recognized that inflexible one-size-fits-all waiting times are ill advised, the proposed final regulations would let health plans establish their own appointment waiting time standards.  Not only would this essentially allow health plans to regulate themselves, but it would also be unnecessarily burdensome for physicians who contract with multiple plans.

The Office of Administrative Law last week rejected the new regulations, saying DMHC failed to provide adequate opportunity for public comment. Although the department did hold two public hearings on the issue last year, OAL determined that the final regulations were substantially different from previous version and that DMHC must allow a full 45 days for stakeholders to comment on the revised regulations.

Click here to read CMA's comments on this issue.

Contact: Armand Feliciano, 916/444-5532 or afeliciano@cmanet.org.