Insurer liability and external grievance review are the hottest health care issues in 1999 for state legislatures, according to the National Conference of State Legislatures.
Thirty-one states are expected to consider HMO liability legislation-one of the most divisive issues of 1998-and 22 states will debate independent appeals following denials of care.
Proponents of health plan liability had difficulty advancing legislation in the states in 1998; bills were defeated in 30 legislatures. Texas remains the only state to have enacted HMO liability legislation.
External grievance review programs, however, are currently in
place in 13 states. The survey also found that 15 states will
consider any-willing provider laws.
Nineteen states are considering laws setting new safety standards
for syringes to reduce the risk of accidental needle-sticks. Maryland
is considering directing the state Occupational Safety and Health
Advisory Board to develop rules by 2001 requiring safer needles.
Maryland hospital association officials are concerned about the
cost of the needles with safety features. Beckton Dickinson, &
Co., which manufactures needles with safety devices, estimates
it would cost a 300 bed-hospital an additional $75,000 a year
to use the new needles.
After eliminating a controversial, Democrat-backed provision that
would have allowed patients to sue their health insurers for malpractice,
the Virginia General Assembly recently approved a "patients'
bill of rights" that would give consumers greater control
over what treatments they receive and which physicians they see.
Business groups and the managed care industry lobbied heavily
against the liability provision.
A tough fight is predicted in Ohio over legislation that would
allow the state's 2.7 million HMO enrollees to sue their plan
for medical malpractice. Under the Patient Protection Act, (H.B.
4) backed by the state's new governor, Robert Taft, HMOs would
be liable for denying physician-recommended care. When the governor
unveiled the act, the leaders of both legislative chambers indicated
they were less than enthusiastic about the concept of allowing
people to sue their HMOs. Representatives of both parties predict
a tough fight on the issue, given the strong opposition from business
and the managed care industry.
A package of four health care reform bills was passed by the New
York State Assembly, including a measure that would hold HMOs
and other health insurers liable for wrongful denial or delay
of treatment. The package of bills, which are backed by a broad
coalition of health care and consumer advocacy groups, are intended
to further regulate the managed care industry and improve enforcement
of existing laws. The key bill in the package would hold health
care organizations liable for wrongful denial of care, delay of
care, or payment for care that they were contractually or legally
obligated to provide or cover.
The New Jersey Senate gave final legislative approval of a bill
that is designed to cut the administrative costs of delivering
health care by encouraging providers and insurers to use electronic
data interchange (EDI) technology to transfer information. The
measure would bring claims processing on-line, require insurers
to pay claims more quickly and offer the health care industry
tax incentives to invest in EDI technology for medical records
and billing. The study concluded that standardized forms and EDI
technology hold the greatest potential for both short-term and
long-term cost savings. The researchers determined that all but
15 percent of the 150 million health claims filed in New Jersey
are currently processed on paper.
The U.S. Supreme Court has rejected the insurance industry's attempt
to overturn a Washington state law that requires HMOs and health
care service providers to provide access to all types of healthcare
providers licensed or certified under state law. The "every-category"
law, the first of its kind in the nation, requires insurers to
cover services by all licensed categories of health care providers,
including chiropractors, physicians, naturopaths and acupuncturists,
physician assistants, registered nurses, podiatrists, and licensed
New Hampshire Gov. Jeanne Shaheen proposed the "Health Maintenance
Organization Accountability Act," which, among other things,
would require managed care organizations to establish external
appeals procedures. The bill would make HMO medical directors
accountable to the state Board of Medicine for treatment decisions
made under their supervision, establish a speedy external appeals
process requiring review panels to issue written decisions within
five days and prohibit financial arrangements with providers that
include incentives to withhold medically necessary treatment.
The Georgia House and Senate approved a bill to allow patients to go outside their HMO network to see a doctor. However, to get the support, Gov. Roy Barnes, who campaigned on doctor choice in last year's gubernatorial campaign, had to increase the premiums patients pay to go outside the network. In some cases the premium more than doubles the 7.5% cap originally proposed; in other cases patients may have to pay 20% more in copayments. The Georgia House and Senate also approved a bill allowing patients to sue HMOs that deny or delay needed medical care, despite some last minute concerns about the definition of "medically necessary." The Senate bill requires patients to submit their claims to an independent review board of doctors before they could file a suit.