Bush Delays Health Plan Appeals Rule
The Bush administration on Monday postponed the implementation of a proposed rule that would give patients additional time to appeal decisions made by health plans covered by the Employee Retirement Income Security Act, the AP/Washington Post reports. Currently, patients have 60 days to file appeals, but the Labor Department rule would extend that time to 180 days. Also under the rule, health plans would be required to offer "specific reasons" for denying care and to "fully disclose" their decision procedures (AP/Washington Post, 7/9). The regulation, originally published in the Federal Register by the Clinton administration on November 21, 2000, would have gone into effect on Jan. 1, 2002. It is scheduled to now become effective between July 1, 2002, and Jan. 1, 2003 (Federal Register, 7/9). Announcing the delay in the Federal Register, the administration said "more guidance" was needed to be given to health plans in order "to ensure efficient and effective implementation of the new rules." Officials pointed to "a number of issues ... raised by plan sponsors, service providers, state regulators and others concerning the interpretation and application of the various provisions and requirements."
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Consumer advocates "criticized" the decision, the Post reports. Judith Lichtman, president of the National Partnership for Women & Families, said, "If the administration were serious about protecting patients, the president would stop talking about patient protections and start providing them." The delay comes two weeks after the Senate passed patients' rights legislation (S 1052) sponsored by Sens. John McCain (R-Ariz.), Edward Kennedy (D-Mass.) and John Edwards (D-N.C.) that would "rewrite ... rules that now protect [managed care organizations] from patient complaints and lawsuits." Bush has said the bill would "open the gates for numerous lawsuits that would threaten businesses" (AP/Washington Post, 7/9). Under the bill, patients could sue HMOs in state court for denial of benefits or quality of care issues and in federal court for non-quality of care issues. The legislation would cap damages awarded in federal court at $5 million, but state courts could award as much in damages as the state allows To view the full text of the announcement in the Federal Register, go to http://frwebgate3.access.gpo.gov/cgi-bin/waisgate.cgi?WAISdocID=5707512226+0+0+0&WAISaction=retrieve.