MARYLAND: Providers Urge HMO Appeals Legislation
"Physicians, social workers, hospital officials" and other health care professionals testified yesterday before three Maryland House of Delegates committees "in support of a bill that would set up a streamlined appeals and grievance process to deal with complaints about HMOs." The Baltimore Sun reports that state House Speaker Casper Taylor Jr. (D) has made the bill "a top priority in the 90-day General Assembly session that ends in April." Although "a similar bill died in the Senate on the last night of last year's session," the Sun notes that "HMOs are on board again" in 1998, "hoping that passage of the appeals bill will stall the momentum for legislation they see as even more onerous."
The House bill, sponsored by Del. John Donoghue (D), "seeks to spell out appeals rights for patients whose HMOs have refused to cover procedures recommended by their physicians." Maryland patients currently have the right to appeal HMO treatment decisions to three state agencies, "but those avenues are only lightly used and poorly publicized," the Sun reports. "The Donoghue bill would concentrate regulatory power over HMO coverage decisions in the hands of the Maryland insurance commissioner," and give the "insurance commissioner new powers to regulate HMO medical directors." The bill also would "give the attorney general's office authority to help consumers prepare their initial appeals process." Finally, "[t]he bill would set deadlines for HMOs and the insurance commissioner to act on appeals, require that customers be notified of their rights and provide for an expedited appeal process in the case of emergencies."
Time To Jump On Board
According to D. Robert Enten, a lobbyist for the Maryland HMO industry, "the industry supports the appeals and grievance provisions of the legislation and can accept the regulation of medical directors by the insurance commissioner." However, he said HMOs oppose "another measure that would make HMO medical decisions answerable to state medical licensing authorities for wrongful denials of coverage" (Dresser, 1/29).