Patients Required to Have Primary Care Physician in California ACA

Patients who do not have a provider after 60 days will be assigned a physician.

The Affordable Care Act marketplace Covered California is now requiring that patients who sign up for their plans in 2017 to have a primary care provider.

If they do not have a provider after 60 days, they will be designated a physician, nurse practitioner, or physician’s assistant. This latest rule comes soon after steep increases were announced for marketplace premiums in the upcoming enrollment period.

Officials said this new rule was implemented to improve quality and cost-efficiency, according to California Healthline.

The Consumers Union, which has a seat on the advisory committee, is in favor of this rule, but cautions that Covered California must still allow patients to change physicians if needed. This new rule is the start of a shift towards managed care, but primary care providers who are assigned to patients will not be as binding as HMOs.

If every patient has a primary care physician, it could avoid medical costs due to duplicate tests, or even hospital admissions, according to the article. It also has the potential to improve health outcomes for patients who otherwise would not see a physician as often.

However, the success of this new law is contingent on how well it is monitored to ensure there are enough physician options for patients, and they can switch providers if needed.