MANAGED CARE: Patients’ Rights Legislation Clears Michigan House

      The state House passed legislation Tuesday that would allow health plan enrollees to sue HMOs and insurers for wrongful treatment decisions, the AP/Detroit News reports. In approving HB 5221, House lawmakers shot down "amendments that would have put the same caps on damages for HMO liabilities that doctors face for medical malpractice -- $280,000 for noneconomic damages." As it stands, the legislation "pits physicians and consumer groups against business interests," which include Michigan's Big Three automakers and hospitals. Supporters believe it will force HMOs to weigh "more than the bottom line when making decisions," while opponents say it could provoke losses and increase the number of uninsured.

Further Clarification Needed
      "It's time to hold HMOs accountable for treatment decisions," said the bill's sponsor, state Rep. Laura Baird (D). Baird noted that current law prohibits health plan enrollees from recovering more than the cost of denied treatment and excludes malpractice and damages recovery. However, Michigan Association of Health Plans Executive Director Eugene Farnum said "the state of the law is too vague for Baird's bill to clear anything up." He emphasized that HMOs cannot be sued for "all kinds of liability." Farnum said the state's recently enacted Patients' Bill of Rights "should be given a chance to work." That law, the AP/Detroit News notes, gives patients the right to "appeal HMO decisions to a state referee." The AP/Detroit News reports that the House bill "faces an uncertain future in the Republican-controlled Senate, and does not have the support of" Republican Gov. John Engler (6/4).