Next year, California will become the first state in the nation with rules that spell out how long patients in managed-care plans have to wait to see a doctor.

The rules will require that patients in HMOs be seen within:

• 10 business days for appointments for non-urgent primary care or mental health care
• 15 business days for non-urgent appointments with specialists
• 48 hours for urgent care appointments
• 96 hours for urgent care appointments that require special authorization

HMOs also must provide round-the-clock telephone triage -- 24 hours a day, 7 days a week. And, patients should not have to wait more than 30 minutes to have calls returned by a doctor or other qualified medical professional, according to the regulations.

The regulations actually have been in the works for several years. In 2002, the California legislature passed a "timely access" law, which called for the state Department of Managed Health Care, which regulates HMOs, to develop standards and enact regulations to reduce waiting periods for the 21 million California residents covered by HMOs. A study done by the department last year found that, in Los Angeles, people who belonged to HMOs and PPOs faced wait times of 59 days, on average, to see a family practice physician.

"California patients are literally sick of having to wait weeks to see a doctor," Cindy Ehnes, the department director, said in a prepared statement. "What good is health coverage if a patient can't find a doctor taking new patients or within driving distance? These new rules say that patients can reasonably expect to have timely access to needed health care."

The California Medical Association, which represents 35,000 doctors in the state, supported the 2002 law, said Andrew LaMar, a spokesman for doctors' group. However, it's taking a neutral stance on the new regulations. One concern, he said, is that doctors will feel pressure to rush patients through appointments to comply with the new rules.

"We're taking a 'wait and see attitude,' " LaMar said. "We're hopeful the regulations will work as intended, but we have some concerns, and the only way to really know is to see what happens when they are fully implemented."

Another concern is that some HMOs will continue to have inadequate networks, or too few doctors or specialists to meet patient demand and the wait time rules, LaMar said.

"We believe timely access is a good thing -- every doctor will tell you that -- but you have to have the infrastructure in place to allow that," LaMar said. "If you don't have enough physicians to treat your patients, and you add on the requirement you have to treat within a certain number of days, then you create some real problems."

California already required that HMOs have a minimum number of physicians for the number of patients served, but until now there's been little monitoring of compliance, he said.

HMOs have until mid-October to submit plans to the state spelling out how they will meet the regulations. Some might have to revise contracts with physicians and physician networks. The new rules put the burden of compliance on HMOs, not individual physicians, according to the state health-care agency. The regulations allow HMOs that don't comply to be fined.

Anthony Wright, executive director of Health Access California, a consumer group that supported the law, said the regulations should compel HMOs to contract with a sufficient number of doctors and specialists in each geographic area to serve their members.

The regulations also have the potential to reduce the inappropriate use of emergency rooms by allowing patients to get in to see primary care doctors in a timely manner, Wright said.

"We think this will be a big benefit for health-care consumers and for the health system as a whole," Wright said. "For consumers, too often care delayed is care denied when people find they can't get in to see a doctor or a specialist for weeks, if not months. We expect to see a lot less inappropriate use of the emergency room."