MANAGED CARE REFORM: Blue Cross Tracks State Efforts
The Blue Cross and Blue Shield Association yesterday released a study that identified two major health care reform trends in state legislatures nationwide. According to the annual study, state legislatures in 1997 focused primarily on creating new regulations to improve quality of care, as well as laws to improve access for low-income populations. Susan Laudicina, director of research for Blue Cross, said, "In response to perceived abuses in the managed care industry, lawmakers enacted a variety of regulations on managed care networks, in addition to new mandated benefits that impose clinical practice standards."
Quality Of Care
Among states' major quality-of-care reform movements were proposals to make health plans liable for malpractice. And while 18 state legislatures debated these measures in 1997, only two states -- Texas and Missouri -- actually enacted them. Other popular quality reforms in 1997 were requirements that plans allow direct access to specialists -- particularly to OB/GYNs -- and laws banning "gag clauses" from provider contracts. Fourteen states passed measures expanding access to specialists, and 24 passed "gag clause" bans, bringing the total with such bans to 39. Twenty states passed new laws requiring plans to cover emergency room services, such as screening and stabilization. Mental health parity laws passed in eight states. Lawmakers in every state introduced at least one bill to mandate medical coverage policies. The Blue Cross researchers found hospital-stay mandates for particular procedures to be somewhat less popular than in 1996, with only 14 mastectomy hospital-stay mandates passing state legislatures in 1997, compared with 30 maternity-stay mandates in 1996.
Nearly every state proposed formal planning or enacted new legislation to expand insurance coverage to children of low-income families. The federal Children's Health Insurance Program gives states a $24 billion block grant incentive to enact such legislation. A "large portion" of states crafted new legislation to conform to the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996. A majority of these states "sought a federal waiver to implement an alternative state mechanism to meet HIPAA's group-to-individual portability requirements. Fourteen states chose the 'federal fall-back' provision."
The Blue Cross researchers also identified major issues that are likely to surface in state legislatures this year. Some of these are carry-overs of last year's big issues, such as the extension of malpractice liability to health plans (21 states), "bills enacting a framework of quality standards (16 states)," and mental health parity bills (19 states). In addition, 15 states will debate laws allowing self-referral to specialists, and 10 state will consider requiring plans to cover emergency room services in cases where a "prudent layperson" believes emergency treatment is warranted (release, 2/12).