In the waning hours of President Clinton's administration, HHS issued new patient protections for beneficiaries enrolled in Medicaid managed-care plans, implementing provisions of the Balanced Budget Act of 1997.
The regulations, Clinton said, are consistent with the goals of a long-discussed but highly controversial patients' bill of rights. The mandates for Medicaid HMOs include: coverage of emergency healthcare services; direct access to women's health specialists; the option of a second opinion for beneficiaries; and no restrictions on communications between provider and patient.
The regulations, which were published in the Jan. 19 Federal Register, become effective at the end of April.
Under a provision HHS calls one of the most important, states must guarantee continued access to care for beneficiaries who change health plans but have ongoing needs. In addition, both states and HMOs must measure the appropriateness of medical services being provided to people with "special healthcare needs."
"All Americans-whether they are in Medicare, Medicaid, or private health plans-deserve the basic protections that a patients' bill of rights provides," outgoing HHS Secretary Donna Shalala said in a written statement.
A spokesman for the American Association of Health Plans said officials were reviewing the regulations and were not yet prepared to comment. The American Hospital Association's Washington counsel praised the regulations, saying they provide individuals with the "assurance and comfort that they are going to be covered."
HHS also took the opportunity to eliminate the "generally outdated regulatory ceiling on what states may pay managed-care plans." That regulation will expand coverage to the growing number of chronically ill Medicaid patients, who can be prohibitively expensive to manage. It is the only rule in the batch still subject to a 60-day comment period.