Florida is launching a state-sanctioned ombudsman program for managed care consumers. Volunteer medical and other professionals as well as consumer representatives will operate under the Agency for Health Care Administration, investigating complaints and assisting consumers in filing grievances and appeals against their health plans. Minnesota and Nevada also have ombudsman programs.
The Mississippi State Medical Association is seeking passage of legislation that would narrow the window for filing a claim of medical malpractice. The current language is "two years after discovery." The proposed legislation would read "two years after discovery, but in no case more than seven years after the alleged act or omission."
Insurers are raising issue with the Department of Insurance’s (DOI) interpretation of the "open access" language of proposed health care legislation. They claim the DOI’s interpretation would allow patients to see any doctor, even those outside the network, without a referral, which they claim would hinder cost control or control of quality. Proposed health care legislation also includes a bill that would promote prompt reimbursement of insurance claims.
Legislators are considering replication of Massachusetts’ new physician profiles program, which provides a "hotline" that provides consumers with information about physicians. Legislators are also considering creation of a full-time MD examiner to investigate complaints against physicians.
Rhode Island is implementing a law that requires managed care plans to disclose to health care consumers their policies on referrals, prior authorizations, coverage of experimental treatments and emergency care access as well as financial and other information.
Health maintenance organizations are gearing up to begin submitting data on quality measures that state regulators will begin collecting on July 1. The requirement is part of a mandate from a 1995 law. A report on the data is expected to be issued the following September in time for open-enrollment.