With broad support and advice from various constituency groups, New York Gov. George Pataki last week unveiled a comprehensive legislative package designed to strengthen protections for HMO enrollees.
Although several states have attempted to mandate patient protections through legislation, most of the measures have failed to become law.
Pataki's bill represents a consensus of HMO, insurance, physician, consumer and business leaders who participated in months of negotiations. It replaces managed-care legislation he introduced last year that many observers believed didn't go far enough.
The compromise bill contains detailed requirements affecting the types of information that HMO enrollees must receive, the design of consumer grievance procedures and the contracting rights of HMO physicians. The bill also would prohibit "gag clauses" that restrict doctors' ability to discuss treatment options with patients.
"I think it underscores the anxiety that many share," said William Gold, president of Gold Health Strategies, a New York-based consulting firm specializing in managed healthcare systems.
Speaking last week at a meeting sponsored by the New York Business Group on Health, Gold, the group's chairman, acknowledged the need for more consumer information on managed-care plans. "We really need to help in distinguishing among the better and the worse," he said.
Separately, the Healthcare Association of New York State is preparing to push its own legislation enabling healthcare networks to contract directly with Medicare, Medicaid and employer groups.
The measure, introduced April 17 in the state Senate and Assembly, would establish a process for certifying provider-sponsored networks. Networks that meet certain financial and operational criteria would be certified by the state to enter partial or full capitation contracts.
Association President Daniel Sisto said PSNs "offer a vehicle for the improvement of public health" because any profits generated would be reinvested in the community.