MANAGED CARE: Davis Vetoes Two Reform Measures

      Gov. Gray Davis vetoed two managed care bills yesterday. AB 58 would have required health care professionals "making a medical necessity decision" for HMOs to be licensed to practice medicine in California. The measure, Davis said, would prevent managed care providers from consulting out-of-state medical experts on critical decisions. "Out-of-state expertise provides significant benefits to patients, especially when dealing with rare diseases," Davis explained, adding, "While I believe very strongly that physicians should be making medical necessity decisions, the requisite expertise to make these decisions sometimes lies beyond our borders." Davis also pointed out that SB 59, which he recently signed, already requires HMO medical directors to be licensed in-state. The other bill rejected by the governor, AB 469, would have provided that enrollment in the state's Medi-Cal managed care program become "voluntary for beneficiaries who are eligible for benefits under the federal Supplemental Security Income for the Aged, Blind and Disabled Program and eligible low-income infants and children, in areas specified by the Director of Health Services for expansion of the Medi-Cal managed care program and where the department is contracting with various entities for those benefits" (bill text). Davis said, "Reducing the number of beneficiaries otherwise eligible to be enrolled in managed care plans would reduce the fiscal viability of the plans, which rely on size and economy of scale to manage the care of beneficiaries" (Davis release, 10/6).

On a Roll ...
      Davis vetoed several other health care-related bills this week, including AB 851, which would have required schools to instruct students in grades 7 through 12 on AIDS and STDs prevention (bill text). Calling the measure "unnecessary," Davis said that education codes already order schools to "stress that sexually transmitted diseases are serious possible hazards" (Davis release, 10/5). The governor approved SB 656, a bill that will increase weekly disability insurance from $336 to $490 for "workers who cannot perform their jobs because of pregnancy or a nonindustrial injury" ( San Francisco Chronicle, 10/7).