PATIENTS’ RIGHTS: Senate Bill Already Law in Many States

A report released by the National Conference of State Legislatures (NCSL) finds that many states have already enacted key provisions of the Senate's recently passed HMO reform bill, American Medical News reports. According to the report, 29 states have passed a law mandating independent review of medical decisions, "which is rapidly becoming the most popular of the managed care reforms enacted by states." The following seven proposals, comprising the remainder of the Senate bill, are already law in at least nineteen states:

Ban on gag clauses (passed in 47 states);
Coverage of screening and stabilization in emergency room (passed in 36 states);
Direct access to an OB/GYNs (passed in 36 states);
Prudent layperson standard for admission to the emergency room (passed in 35 states);
Disclosure of restrictive formularies by plans (passed in 28 states);
Allowing certain patients to retain their doctor for a certain period of time when switching health plans (passed in 22 states);
Minimum stay for a mastectomy (passed in 19 states).

Critics of the Senate's effort argue that "the bill lags behind the patient protection provisions already enacted by most states." But supporters say "Congress should wait until the states test controversial measures such as HMO liability," which only two states, Texas and Georgia, have enacted. One problem with the Senate bill, critics say, is that it is not as similar with state proposals as it may seem. For instance, the Senate's continuity-of-care provision applies only to those who are near death, while many states apply the rule to anyone with chronic conditions. Others simply favor a more centralized approach when it comes to HMO reform. Judy Waxman, director of government affairs at Families USA, said, "Consumers aren't going to like all the variations. You should have a uniform rule for everybody, wherever they live." But, American Medical News reports, the Senate bill would actually boost patient protections passed by states, as it applies to self-insured plans. Federal law currently prohibits states from applying patient protection laws to such plans (Page, 8/16).

See: West Virginia
West Virginia Insurance Commissioner Hanley Clark told state legislators Tuesday that the state's strict HMO laws, including required monthly reports and annual licensing, have resulted in more protection for consumers than in other states, the Charleston Gazette reports. "We are a leader in the country," Clark said of the state's HMO laws. Yet, of the seven HMOs operating in the state, only one -- Optimum Choice -- has turned a profit, and the state's tough stance may force others to flee. "I would be surprised if we have more than five by the end of the year," Clark added (Seiler, 8/18).

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