PATIENTS’ RIGHTS: Bipartisan Bill Introduced In House
In yet another legislative attempt to impose patient protection requirements on health plans, a bipartisan group of House lawmakers yesterday introduced the Guaranteed Access for Patients (GAP) Act (HR 3547). The bill "would help patients and put an end to inadequate coverage by instructing for-profit managed care plans to incorporate" basic protections, said Rep. Sherrod Brown (D-OH), one of the sponsors. The proposed patient protections are: prohibiting financial incentives that result in the withholding of care or the denial of referrals; allowing patients to seek out-of-network services "if medically necessary"; requiring information to be provided about a plan's services and benefits; disallowing "gag clauses" in physician contracts; mandating a patient's right to an appeal in cases where care is denied, and assuring adequate access to "in-network" specialists whenever medically necessary. The legislation was co-written by Brown and Rep. Dave Weldon (R-FL) and is cosponsored by Reps. Ted Strickland (D-OH), Tom Coburn (R-OK), Gene Green (D-TX) and John Cooksey (R-LA). "Most of the protections in our legislation were included in the Medicare portion of last year's balanced budget agreement. If Congress believes these standards are necessary to protect Medicare beneficiaries, then patients enrolled in private health plans should have the same basic rights," Brown said (release, 3/27). Today's Wall Street Journal "Washington Wire" column reports that Rep. Charlie Norwood (R-GA), "author of the most far-reaching managed care bill" -- the Patient Access to Responsible Care Act -- "says the specialists' bill doesn't hold health plans legally liable, as his does" (3/27). Today's Los Angeles Times looks at the lobbying campaign businesses have launched to defeat Norwood's managed care bill (Rubin, 3/27).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.