MEDICARE HMOs: Administration To Appeal Ruling On Rights
Today's New York Times reports that the Clinton administration is appealing an August court ruling "that gave new rights and consumer protections to six million Medicare beneficiaries" enrolled in managed care plans. The August decision, handed down by a three-judge panel of the 9th U.S. Circuit Court of Appeals, concluded that "decisions by Medicare HMOs amounted to government actions, so that patients denied specific services were entitled to 'due process of law,' including hearings and other protections." The Department of Health and Human Services is appealing the ruling to the full 9th Circuit, arguing that "the government should not be held accountable for the actions of HMOs that sign contracts with Medicare." According to the administration, such actions "are predominantly medical decisions that turn on independent professional judgment." An HHS legal brief "complains that the appeals court imposed 'highly detailed, burdensome and, in many instances, wholly unnecessary procedural requirements on HMO decision-making'" (Pear, 10/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.