Davis Proposes Change to Referral Law to Allow HIV/AIDS Patients Easier Access to Specialists Through HMOs
Gov. Gray Davis (D) on Sunday announced that he will propose changes to the state's patient rights law to ensure that people with HIV/AIDS are referred to qualified HIV specialists through their HMOs, the San Jose Mercury News reports. In a telephone press conference held to preview the health care initiatives contained in Davis' State of the State address tomorrow night, Davis said the proposed revisions would "close a loophole" in the law that allows HMOs to refer patients to doctors who may have never dealt with HIV/AIDS patients before (Feder, San Jose Mercury News, 1/7). The 1999 Standing Referral Law (AB 2168) requires managed care companies to refer HIV/AIDS patients to specialists in the disease, but regulators "found that some of the HMOs were using the lack of a clear definition of an HIV/AIDS specialist to send those patients to people who are not qualified," Daniel Zingale, director of the Department of Managed Health Care, said. The proposed revisions, which were drafted by the DMHC in conjunction with the American Academy of HIV Medicine, would require that doctors have a "minimum amount of current, up-to-date clinical experience" with HIV/AIDS patients before they can be declared HIV/AIDS specialists by HMOs. Such specialists would also have to participate in continuing education initiatives on HIV/AIDS to maintain their designation (Durham, Associated Press, 1/7). The revisions must be approved by the Office of Administrative Law before taking effect on July 1, but approval is expected "in a matter of weeks," Zingale said.
Zingale yesterday also announced that the DMHC will seek to require all HMOs to cover out-of-area emergency maternity services. The changes were prompted by the case of an HMO that refused to cover the cost of labor when a Los Angeles woman delivered her baby two weeks early while on a trip to San Diego. The DMHC ruled that the company had to pay for the services because the insurer could not deny emergency coverage to the patient. The HMO had argued that the woman should not have traveled so close to her due date. "Pregnant women should not be restricted to their homes just because the HMO says so," Zingale said (San Jose Mercury News, 1/7).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.