DMHC Proposes Regulations Requiring HMOs to Reveal More Information About Arbitration Cases
The Department of Managed Health Care has proposed regulations that would require HMOs to provide the agency with additional information to investigate patients' complaints, eliminating the "secrecy of the current arbitration process," the Los Angeles Times reports. Under current guidelines governing the arbitration process, health plans are required to provide "only ... altered copies" of arbitration decisions, which exclude the HMO's name, the patient's name, the doctor's name or "any other identifying information." The proposed regulations would require HMOs to submit complete copies of all arbitration decisions to the DMHC within 30 days of the decision. In addition, the proposed regulations would require all arbitration settlements to allow patients to discuss their cases with DMHC regulators. According to DMHC Director Daniel Zingale, some patients have expressed reservations about revealing information pertaining to their cases against HMOs because they "were afraid of violating confidentiality agreements." Zingale said, "There's very serious reason to believe that the current system gives HMOs an advantage over patients, and we need to take a closer look at that. We want to create a more equal playing field for patients."
For their part, managed care plans have said that the proposed regulations are "overly intrusive" and would "violate the privacy of patients." In addition, HMOs say that the regulations would "constitute [an] additional -- and unnecessary -- regulatory burden" and would exceed DMHC's "regulatory authority." The California Association of Health Plans contends that the regulations are not necessary because arbitration cases between patients and HMOs are "few and far between." CAHP President Walter Zelman said, "If the department is looking for information on how the arbitration process is working, what they're going to find is that there's not a lot of data." Data released by the state showed that "few if any" arbitration requests were filed with health plans between January and October 2000, the Times reports. Still, consumer advocates have "praised" Zingale for attempting to collect more information on arbitration cases. Advocates say that while the "number of arbitrations is small ... the cases represent real patients with real problems." Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights, said, "What the department has finally realized is that arbitration is an iron curtain that the public can't see through and it only has limited ability to see beyond." The Times reports that the DMHC is currently reviewing public comments on the regulations and will submit the final proposal to the Office of Administrative Law (Ornstein, Los Angeles Times, 2/15).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.