January 1997 Bulletin

House gets bill on choice, access

The Patient Access to Specialty Care Coalition is urging support for the Medicare Patient Choice and Access Act of 1997 - H.R. 66.

The bill, introduced Jan. 7 by Rep. Tom Coburn, (R-Okla.) and Sherrod Brown (D-Okla.), assures timely and appropriate in-network access to specialists; guarantees that beneficiaries in managed care plans will have the option, at the time of enrollment, to select a plan with coverage for out-of-network services; and institutes a timely appeals process in disputes between a patient and the health plan.

The bill also ensures enrollees are aware of their rights and restrictions in the plan, prohibits financial incentives that reward physicians for not referring patients to specialists, and bans "gag clauses."

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