HMO REFORM: Business Groups, Insurers Oppose New Rules
Insurance and business groups yesterday warned of rising health care costs and cuts in patient care if the Clinton administration's new rules for federal health plans, which would force HMOs to pay claims more quickly and expedite patient appeals, are adopted. The warnings came on the final day of the comment period for the proposed rules. Under the proposed rules, health plans will have "just 15 days" to decide whether or not to pay for routine care, and must decide more quickly for emergency care. Business groups complained that the rules allow no extra time even when care has already been provided and "a doctor is simply waiting for a bill to be paid." The rules will also allow patients to take cases to court more easily, a move which industry officials complained will drive up costs. Labor Department officials contend that patients have the right to go to court with their complaints, and note that patients can collect damages only for the cost of treatment, not legal fees or pain and suffering. The American Association of Health Plans' Rick Smith said, "We're concerned that the end result could be unworkable rules, higher costs and lower quality decisions." But the Labor Department's Meredith Miller said the new rules were "one of the few things" that the administration can do in the way of patients' rights, since attempts to legislate such rights have failed in Congress. "We're trying to accomplish fairness for people ... so they can get decisions ... in a speedy fashion," she said (Meckler, AP/Philadelphia Inquirer, 12/10).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.