Under HCFA's new regulations on HMO grievance procedures, Medicare risk plans will have 72 hours to rule on a beneficiary's appeal of a denial of care when the denial puts the beneficiary's life or health in immediate jeopardy.
Current regulations give health plans 60 days to rule on a Medicare beneficiary's appeal. The new regulation will require plans to develop speedier appeals procedures within 120 days and notify all Medicare enrollees of their new appeal rights.
The new regulations were developed with the help of the managed-care industry, which gave them a favorable review.
"Medicare beneficiaries should have the information they need to understand their rights and . . . timely procedures should be in place to permit them to pursue their rights," said Karen Ignagni, president of the American Association of Health Plans, which represents the managed-care industry.
The American Medical Association also supported the new regulations, which include a provision that will allow any physician, not just those affiliated with the patient's managed-care plan, the right to initiate an appeal.
"The (AMA) applauds the new Medicare appeals regulation that puts patients before paperwork," said Daniel Johnson, M.D., president of the AMA.
HCFA Administrator Bruce Vladeck said the new Medicare regulations should be implemented by the private sector as well.
Additional rules will be released later this year governing the continuation of care during the appeal process, appeal rights when services are reduced and new standards for appeals in cases when care is not urgent.