California became the first state to mandate that HMOs in the state provide care to their members within set time limits, a move that health plans say could lead to higher premiums.

The new rules, being phased in over the next year, require consumers to obtain a primary care appointment within 10 days and an appointment with a specialist within 15 days. Doctors must return a patient’s call for care within 30 minutes.

About 21 million California residents are enrolled in HMOs, and because of doctor shortages in the state, their medical visits can be delayed, up to 59 days on average for Los Angeles residents, according to a 2009 survey by Merritt Hawkins & Associates, a doctor recruiting firm.

Health plans and state officials warned that the rules could exacerbate shortages in doctors in the state.

The California Department of Managed Health Care said it would consider granting exceptions to the rules in cases where doctor shortages experienced by HMOs are acute.

Its rules, which began to take effect Jan. 17, respond to a 2002 law (AB2179), authored by Assemblywoman Rebecca Cohn, that sought to address frequent consumer complaints about their inability to get health care advice or appointments within a reasonable amount of time, according to Health Access California, a nonprofit organization supporting patients rights in California.

The new rules provide “groundbreaking consumer protections,” said Health Access California in a statement.

“The new rules ensure that when managed care consumers agree to a limited network of providers, insurers fulfill their promise that their networks of doctors and specialists have the capacity to take care of their paying patients,” the group’s statement said.

The group suggests that the new requirements may shine a light on carrier networks that are lacking capacity and potentially decrease emergency room overcrowding as plan members obtain necessary care from their doctors, not hospitals.

But the California Association of Health Plans told the New York Times that faster response times could mean premium hikes, although the association representing the state’s 29 HMOs, could not specify how much of an increase could be expected.

Under the rules, telephone screening or triage must occur at all hours; plan members cannot be forced to wait on the phone for more than 30 minutes; and wait times to speak to a plan’s customer service representative cannot exceed 10 minutes during normal business hours.

Urgent care appointments that do not require prior authorization must occur with 48 hours, while urgent care appointments requiring pre-authorization, including visits to specialists, cannot be delayed past four days. Mental health appointments must occur within 10 business days and non-urgent care for ancillary care services for diagnosis or treatment of an illness, injury or health condition, including X-rays and lab tests, cannot be delayed past 15 business days.

Dental HMOs must provide urgent care within 72 hours, non-urgent care within 36 business days and preventive care to plan members within 40 business days.