HMO REFORM: DOC Rejects CMA’s Petition For Change
The state Department of Corporations last month rejected the California Medical Association's formal request that the department "beef up state regulations requiring health plans to have 'fair and reasonable contracts' with doctors." The American Medical News reports that in declining the CMA's petition, the DOC said "it lacked sufficient evidence to support the need for additional regulation." In addition, the DOC rejected another CMA petition that asked the state to "more stringently enforce" the Knox-Keene law so that HMOs would be held responsible for about $60 million in doctors' bills owed by the bankrupt FPA Medical Management Inc.
Watcha Gonna Do?
DOC spokesperson Julie Stewart said the department rejected the CMA's contract petition because there was not "substantial and credible evidence" to support adding more regulations to the state law. She said in order to change the law, the DOC "needs testimony from individual physicians that provides specific evidence that doctors or patients were harmed by the contract terms." The CMA contends, however, that "testimony is not needed in a petition to change regulations." CMA attorney Astrid Meghrigian said all the CMA needs to do is "show a need for new regulations" and demonstrate that the DOC "has the authority to make those changes." The CMA says it will resubmit this petition "along with new supporting material" in early January. If the DOC rejects this second request, the CMA says it will "consider filing a lawsuit." Meanwhile, the CMA is hoping that the DOC will become "more sympathetic to patients' and doctors' concerns about managed care" as Gov.-elect Gray Davis will soon appoint a new head to the department (Jacob, 12/14).