State legislatures have no intention of letting Washington policymakers dominate the dialogue over patient rights this year.
As Congress prepares to debate a patient rights bill, legislatures across the country are taking up their own consumer rights bills, and a host of other health-related bills that will affect physicians.
Managed-care regulation and children's health issues will dominate debate in state legislatures this session, according to the National Conference of State Legislatures in Washington.
Comprehensive consumer rights bills will be high on the agenda in the Illinois, Massachusetts, Pennsylvania, South Dakota and Wisconsin legislatures. The bills vary in their particulars but in general all would require managed-care plans to disclose information on benefits, services and grievance procedures. They also would require plans to supply an adequate network of providers and establish ombudsman programs to assist consumers in choosing a managed-care plan and understanding their rights as plan members.
Consumer concerns about managed-care policies and quality will continue to drive legislation but under a new guise, says Molly Stauffer, NCSL senior policy specialist. "Last year the legislation (including bills banning gag clauses) was labeled as anti-managed care," Stauffer says. "This year, it's called consumer protection, but it's really the same thing."
In trend-setting California, managed-care reform will dominate the session, but the legislation will be piecemeal, with no single comprehensive bill, Stauffer says. Republican Gov. Pete Wilson vetoed close to 40 health-related bills last year, but the release of the state's Managed Care Task Force Report will drive most legislative action this year. The report recommended establishing a third-party review process for claims denial appeals and providing easier access to specialists.
Nineteen states will be debating the issue of HMO liability and whether patients can sue HMOs for medical malpractice (see related story, page 68). The state bills mirror federal legislation, sponsored by Sen. Alfonse D'Amato (R-N.Y.) and Rep. Charlie Norwood (R-Ga.), that would make it easier for patients to sue health plans.
Some of the states' liability bills also would prohibit "hold-harmless" or indemnification clauses in provider contracts. A provider who signs a hold-harmless contract and is sued for malpractice cannot bring the insurer into the action, even if the provider feels company policy led to the negligence claim. Whether as part of their HMO liability bills or as independent legislation, 14 states will consider prohibiting hold-harmless clauses, according to NCSL policy specialist Marla Rothouse.
Also on the managed-care front, Delaware might consider regulating the elimination of physicians from managed-care networks. Other states' liability laws include similar provisions.
A number of states are considering legislation that prohibits providers from shifting financial liability to patients when their insurers fail to pay the provider. Such measures were enacted last year in Arkansas, Colorado, Ohio, Oregon and Virginia. Rhode Island, Washington and Massachusetts will consider carry-over measures in this session.
Fourteen states will consider providing consumers with access to profiles of physicians. Massachusetts last year instituted a physician profile program on which many states have based legislation. By dialing a toll-free number, Massachusetts residents can obtain information ranging from a physician's education, specialties and hospital affiliations to disciplinary actions and malpractice settlements involving the physician. Illinois is considering establishing a similar toll-free line, while Florida, Kansas, Rhode Island, Tennessee and Vermont are considering legislation that would deliver physician profiles via electronic media.
Connecticut, Maryland, Mississippi, New Jersey, Pennsylvania and Wisconsin are considering regulating provider-sponsored organizations. Some are considering solvency requirements; others are considering whether PSOs should be state-regulated in the same manner as HMOs.
In nearly every state, children's health issues are on the docket. Last year's balanced-budget law provided $24 billion for children's health programs over five years, and about $20 billion of that will go to the State Children's Health Insurance Program. Under SCHIP, states that provide health insurance to more of the nation's 11.3 million uninsured children are eligible for matching federal dollars.