HMO rules stuck in limbo

SACRAMENTO — In 2002, California's HMO czar, Daniel Zingale, declared, "The days are over when they could make patients wait and wait for healthcare."

Zingale was heralding a new law that required his department to ensure that HMO patients received timely appointments with doctors. The law was spawned by the case of a 74-year-old woman who died from an aneurysm in a Kaiser Permanente waiting room while pleading to see her physician.

The Schwarzenegger administration's enactment of the new rules, which the law required by January 2004, has not been prompt. The Department of Managed Health Care did not release its proposed rules until 2007.

When HMOs and doctors groups objected to them, the department scrapped the rules in favor of ones that let health plans come up with their own methods of complying with the law. The plans have to submit their guidelines in October, and the department will review them.

Consumer advocates charge that the way the department is putting the law into action controverts the promise six years ago from Zingale, who is now a senior advisor to Gov. Arnold Schwarzenegger and chief of staff for Schwarzenegger's wife, Maria Shriver.

"The pending rules are a betrayal of consumers and of the clear intent of the law," said Anthony Wright, executive director of Health Access California, a consumer advocate group that sponsored and helped write the original legislation. "The department is letting the insurance companies set their own standards."

Physicians groups that contract with HMOs are not much happier. They complain that the department's rules will revive one of the characteristics consumers have historically disliked most about HMOs: their tendency to micromanage how, when and for how long doctors can see patients.

"This is the problem people were complaining about years ago," said William Barcellona, the chief lobbyist for the California Assn. of Physician Groups. "We've come full circle."

About 21 million Californians belong to HMO networks. The 2002 law was signed by Gov. Gray Davis as part of a widespread backlash against the companies in the late 1990s. Some HMOs had trouble recruiting and contracting with doctors because of a shortage of specialists in some areas and the plans' practice of paying set rates to care for each patient rather than the traditional fee-for-service method.