DISTRICT OF COLUMBIA: Passes Revised HMO Appeals Law
The D.C. Council passed a patients' bill of rights measure yesterday that allows residents denied coverage from their health plans access to an independent review panel. At the last minute, however, council members attached a controversial amendment that some say might compromise the measure. The Washington Post reports that the move left consumer advocates scrambling to determine "whether the law was significantly weakened" by the last-minute provision stipulating that the "independent panels will not make the final judgement. HMOs can ignore panel decisions and patients then can take the cases to court." Under the new law, HMOs will perform informal reviews of patient complaints, which then go to an HMO-appointed panel for review. The patient may appeal the panel decision to the D.C. Health Department director, who could steer the issue to an independent review panel. Following that panel decision, the Post reports, "either party can ignore the outcome and sue." Bill sponsor Sandy Allen (D) accepted the amendment "on the spot" and the measure received unanimous approval.
Both Sides Undermined?
Although council member Kevin Chavous (D) said his amendment was "intended only to remove ambiguous language from the bill," it left "lobbyists puzzled." Consumer advocates and HMO representatives alike expressed concern that it "undermined compromises they had worked out." Sue Anderson, law professor at George Washington University and a participant in the negotiations, said, "That really shocks me. The health plans tell me that they don't understand why all the harsh criticism and been leveled against managed care in the media. Now I see why, because they've done their darndest here in the District to get some legislation with no teeth in it." The HMO lobbyists similarly opposed the amendment, calling it a win for trial lawyers eager for more business. "To slip that in now ... it's bad faith," asserted David Wilmot, executive director of the D.C. HMO Association, "The trial lawyers were never at the table, and they come in at the eleventh hour and offer this amendment" (Goldstein/Williams, 12/16).