June 1998 Bulletin

Coalition’s bill in House

Legislation provides timely access to specialists

Rep. David Weldon (R-Fla.) is optimistic that some or all of the provisions of his patient protection bill will find their way into law. The Patient Choice and Access to Quality Health Care Act (HR 3547), that Rep. Weldon and Rep. Sherrod Brown (D.-Ohio) introduced in March, contains the patient protections that Congress wants to provide without creating another bureaucracy, says Rep. Weldon.


Meeting with Linda Ruiz, director, program integrity, Health Care Financing Administration, right, at the National Leadership Conference in Washington, D.C., are, from left, Daniel J. Nagle, MD; Diane Przepiorski, executive director, California Orthopaedic Association; and John O. Lytle, MD.

Only in his second year in Congress, Rep. Weldon is realistic about the way Congress operates. He told the National Orthopaedic Leadership Conference in Washington, D.C. on April 30 that the legislation which is finally approved by Congress may not be known as the Weldon bill, but that doesnít concern him. All that matters, he says, is that the legislation contains the patient protection features he believes are necessary. Rep. Weldon is an internal medicine physician who still sees patients once a month. Heís seen first-hand the need to provide protections such as access to specialty care.

His legislation was developed by the Patient Access to Specialty Care Coalition, which is cochaired by Nicholas Cavarocchi, director of the Academy's Washington office. The bill gives health plan enrollees assurance that they will be able to obtain timely access to specialists in-network, as medically necessary, for covered services. It also assures continuity of care for patients with chronic conditions.

The bill provides a timely independent appeals mechanism in-network; a board of appeals must hear and resolve complaints within 30 days and must provide an expedited hearing for complaints regarding urgent care. Enrollees must receive specific information by the health plans, including patient rights, restrictions on payments and emergency services. The bill prohibits financial incentives between health plans and health care professionals that would act as an inducement to reduce or limit medically necessary services provided to enrollees and bans the use of "gag clauses."


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