PATIENTS’ RIGHTS: White House to Propose New Rules
Because the patients' bill of rights is "languishing in Congress," the Clinton administration announced that it will issue rules that would tighten federal regulation of private health care plans, the New York Times reports. The rules, prepared by the Labor Department and slated to be issued in final form before the Nov. 7 elections, would expand the rights of more than 130 million Americans receiving health insurance through private employers, White House officials reported (Pear, New York Times, 10/9). The new regulations would create procedures to help patients appeal denials of benefits within health plans, set deadlines for such denials and specify information that plans must provide to patients (Murray, Wall Street Journal, 10/10). In addition, patients who feel they have been "improperly denied benefits" are entitled to a "prompt 'full and fair review'" by independent medical experts. Under the administration's proposal, all private employee benefit plans would have to modify their policies to comply with the rules. The Clinton administration viewed the new regulations as a way to bypass the congressional "impasse" surrounding patients' rights legislation. In addition, White House officials commented that Vice President Al Gore could reap the benefits of such actions by "boasting" that the administration is moving to protect patients' rights while "the Republican-controlled Congress fails to act."
While some experts feel that the new rules would "vastly improve" patients' claims and appeal rights, the New York Times reports that they "did not go as far" as the House-passed Norwood-Dingell bill currently stalled in Congress. The new rules would not cover 38 million Americans who have "other types of insurance now regulated by the states," and does not give patients a right to sue HMOs for damages resulting from "improper denial of care," although some provisions would "make it easier" for patients to sue for benefits under existing law. The new regulations would allow a patient to go directly to court if a health plan fails to meet deadlines for acting on claims or does not follow "reasonable claims procedures" outlined by the rules. AAHP Executive Vice President Diana Dennett said that the new regulations "put the claimant on a fast track to federal court and will lead to an increase in litigation." White House Health Policy Coordinator Chris Jennings said that the Clinton administration "[hasn't] given up hope" that Congress will pass a comprehensive patients' bill of rights (New York Times, 10/9). "It's important, but it's limited," Jennings stated, adding that the new regulations are "not a replacement for the patients' bill of rights that we want to see Congress pass." Although Clinton supports the Norwood-Dingell bill and "still hopes to sign it into law as part of his health care legacy," opposition from HMOs and employer groups have "thwarted efforts" to push the bill through the Senate (Wall Street Journal, 10/10).