HMO APPEALS: National Organization Calls For Flexibility
The National Association of Insurance Commissioners urged Congress yesterday to mandate "external appeals" processes for patient grievances -- but asked that lawmakers "not dictate exact terms to the states." CongressDaily reports that Colorado Insurance Commissioner Jack Ehnes testified before the House Ways and Means health subcommittee that Congress "should amend (the Employee Retirement Income Security Act) to provide" the external appeals protections. Generally, states cannot regulate plans under the federal ERISA. Ehnes asked that Congress give states "the utmost flexibility" over external appeals mandates passed at the state level. Unlike the 1996 Health Insurance Portability and Accountability Act, which "required states to enact complex changes to state law within a very limited timeframe," Ehnes said HMO appeals legislation should "first develop an independent external grievance procedure for ERISA plans, and then require the states to implement some type of independent external grievance procedure within an explicit time frame."
Is it Necessary?
Ways and Means health subcommittee members "differed sharply over the need for such a bill," CongressDaily reports. Rep. Pete Stark (D-CA) said, "Nothing is more in the forefront of the public's minds than the almost obscene indifference of the major for-profit health plans to the needs of their patients." Rep. Jim McCrery (R-LA) disagreed, saying the scarcity of complaints by patients in federal plans "does not bear out the statement that this is the most pressing problem" (Rovner, 4/23).