CHILDREN’S HEALTH: Rhode Island Senator Pushes HMO Care Bill
Sen. Jack Reed (D-RI) Friday introduced his "Children's Health Insurance Accountability Act," which would establish a set of managed care standards that are specific and unique to children. The bill ensures children enrolled in managed care plans the right to access pediatricians, pediatric specialists and pediatric hospitals, and safeguards children's ongoing care if a parent changes jobs or the child's doctor leaves the plan. In addition, Reed's legislation pushes for greater accountability in managed care plans, including an internal and external appeals process and more consumer information about care for children. Other specific protections in Reed's bill include: coverage for emergency room visits deemed necessary by a "prudent layperson"; provision of services for children with special needs; establishment of criteria about the best treatment for children; and a requirement for more studies on childhood illnesses and appropriate treatments. The legislation will be referred to the Senate Labor and Human Resources Committee.
Care For The Little Guy
Reed said the legislation, cosponsored by Sens. Edward Kennedy (D-MA) and Patty Murray (D-WA), highlights children's health care needs in the midst of Congress' consideration of managed care consumer rights. He noted that while children account for one-third of Americans enrolled in health plans, many plans overlook their specific needs. One University of California study found that low-income children in public health programs are more likely to receive appropriate medical care than children in private health plans, according to Reed. Additionally, the study revealed that some managed care plans restrict referrals to pediatric specialists and subspecialists for children with complex medical conditions, and that providers who lack necessary experience are attempting to treat complex pediatric conditions. "This is a special population, and it's simply common sense to recognize that they have special health care needs," said Reed. "Sick children deserve a pediatric specialist who understands their unique health care needs," he added (Reed release, 3/20).
Strong Public Support
A poll commissioned by the National Association of Children's Hospitals found that almost nine out of 10 respondents say Congress should require HMOs and other insurance companies to give children access to physicians and hospitals specializing in children's care. Specifically, 89% said parents should be allowed to choose a pediatrician as their child's primary care doctor; 90% said managed care plans should be required to allow parents whose children have special health care needs to choose a pediatric specialist to be their child's primary care doctor and 87% support requiring HMOs and other insurers to measure and report to the public specifically on the quality of children's health care that they provide. "These results demonstrate that Sen. Reed's new managed care legislation for children is absolutely on target," said Lawrence McAndrews, NACH's president and CEO. The survey of 1,000 adults was conducted last month by Lake Sosin Snell Perry & Associates, Inc. and the Terrence Group (NACH release, 3/20).