June 1998 Bulletin

8 states approve new patient protection laws

Patient protection legislation was signed by governors of eight states in the first four months of 1998.

Delaware allows members of managed care organizations to be able to pay outside providers for service and authorizes formation of the Delaware Health Information Network which will compile and communicate patient clinical and financial information.

Idaho decrees that no managed care organization may require as part of any provider contact a clause stating the provider agrees to the lowest reimbursement rate he/she has agreed to charge any other payer or to a requirement that he/she adjust charges to the managed care organization. The provider is not required to disclose his/her contractual reimbursement rates and prohibits "best price" or "most favored nation" clauses in contracts.

Indiana, Kentucky and New Mexico provide comprehensive managed care consumer protection legislation that requires managed care plans to disclose plan details, provide sufficient number and type of specialists, provide coverage for emergency room care without prior authorization, establishes grievance procedures and prohibits "gag clauses" Each law includes a point-of-service option.

Mississippi's patient protection law ensures that the reviewer determining medical necessity is a physician licensed in the state and subject to Mississippi's Medical Practice Act.

South Dakota's law ensures a patient's right to access the patient's own health information and amend the information under certain circumstances.

West Virginia now requires that insurers pay for initial screening and stabilization for individuals who seek emergency room treatment when they believe it is an emergency. The state also creates the Health Maintenance Organization Patients' Bill of Rights, addressing grievance procedures, privacy rights, policies, and service denials.

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