A Senate committee this week will draw first blood on managed-care reform when it votes on a bill that would extend patient protections to enrollees in employer-sponsored healthcare plans.
The Senate Health, Education, Labor and Pensions Committee is scheduled to revise and vote on legislation sponsored by its chairman, Sen. James Jeffords (R-Vt.). It will be the first such bill facing a committee vote in this session of Congress.
Jeffords' legislation, dubbed the "Patients' Bill of Rights Act," largely governs employer-sponsored plans covered by the Employee Retirement Income Security Act, or ERISA.
It would require employer-sponsored plans to provide internal and external appeals mechanisms for enrollees who are denied healthcare benefits.
In providing an internal review mechanism, Jeffords' bill bows to physician lobbying. If a plan denied coverage based on a "medical necessity" determination, the internal review could be conducted only by a physician who was not involved in the initial denial and had expertise in the specific medical condition.
Jeffords' bill also would require ERISA-governed plans to cover emergency, pediatric and OB/GYN care without preauthorization or referral and would provide enrollees with a point-of-service option.
It also would bar plans from restricting what physicians can tell patients about their treatment options.
"I am confident we can provide these protections," Jeffords said at a hearing on patient protection last week. "I believe that the American people expect us to do this in a manner that responds to the real concerns of consumers."
Although observers said the legislation probably has solid enough support among health committee Republicans to fend off Democratic efforts to amend it, they also said its path beyond the health committee is unclear.
It may need to pass through the Senate Finance Committee, where the support of moderates such as Sen. John Chafee (R-R.I.) is uncertain.