HEALTH ACCESS ALERT

Tuesday, August 27th, 2002

END-OF-SESSION LEGISLATIVE UPDATE ON HMO PATIENTS RIGHTS: Attached is a quick update, by Health Access legislative advocate Beth Capell, on the status of key legislation regarding managed care consumer protections, which continues the work around the passage of the California HMO Patients’ Bill of Rights in 2000.

There are other bills of note, but we wanted to get out information quickly on specific legislation that our allies have been following. In particular, we would appreciate any support on the following bills still in play (more info in attachment):

· SB842(Speier), prescription drug coverage for HMO enrollees, hangs in the balance at this writing, on its way to an uncertain fate on the Assembly floor.

· AB2179(Cohn), timely access to care, is awaiting Senate action before returning to the Assembly for final action.

For a recent version of our more comprehensive bill list, visit our web site, at www.health-access.org.

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MANAGED CARE UPDATE: FIRST PARTTuesday, August 27, 2002

Beth Capell, Health Access Advocate.

As the legislative session winds down, key HMO reform legislation hangs in the balance. However, the outcome of several measures has already been determined. Further updates will follow.

Continuity of Care: AB1522 (Thomson) and SB103 (Speier): In late 2000, many consumers had their care disrupted because of a bitter contract dispute between Sutter Health and Blue Cross. Relationships with physicians were abruptly terminated often with only a few weeks notice. In another instance where a medical group went bankrupt, the medical records, including thousands of mammogram films, were held by the group and not released to either affected consumers or the HMOs legally responsible for handling the transfer of the consumers to other physicians.

Health Access and other consumer organizations supported efforts to obtain continuity of care for up to a year after contracts between HMOs and provider groups were terminated. This would allow consumers who have an open enrollment period to take advantage and others who are in the midst of a course of treatment or who have conditions that require multiple doctors sufficient time to make a change. The DMHC in the Davis Administration has supported consumers.

Physicians and medical groups have fought to limit continuity of care to six months. In stunning testimony, the California Medical Association said that disrupting the doctor-patient relationship was a mere “inconvenience” to the consumer and that the important continuity was between the physician and the contract. Senator Speier, chair of the Senate Insurance Committee, has sided with the physicians in advocating for six months of continuity rather than a full year.

Because of this, continuity of care legislation has been stalled in a conference committee for over a year. As of today, Tuesday, August 27, the deadline for conference committees to act, this complicated measure is not in shape to move forward and is unlikely to do so, leaving consumers at the mercy of contract disputes between HMOs and providers for another year.

Medical Group Negotiations: AB1600 (Keeley): This bill, which in some of its many versions was opposed by Health Access as well as many labor organizations, would have voided anti-trust protections to allow medical groups and medical associations to negotiate to set prices with HMOs. These medical groups are often large businesses with hundreds and even thousands of doctors represented. AB1600 was opposed by Health Access because it allowed prices to be negotiated in secret between two groups of businesses (the medical groups and the HMOs) with no role for the consumer or the purchaser, little or no public scrutiny, and dramatic potential to drive up premiums without necessarily improving quality or even compensation of individual physicians.

Health Access supported the right of consumers to sue to enforce the Knox-Keene Act and has also supported regulation of HMO rates if it is done through a regulator with a public process that includes consumer scrutiny and involvement.

AB1600, which had been stalled for almost a year in the Assembly on concurrence in Senate amendments, has failed to proceed to the Governor and is dead for this year.

More to come:

·SB842(Speier), prescription drug coverage for HMO enrollees, hangs in the balance at this writing, on its way to an uncertain fate on the Assembly floor. Health Access and other consumer and constituent organizations will be fighting for its passage.

·AB2179(Cohn), timely access to care, is awaiting Senate action before returning to the Assembly for final action. Little active opposition to this measure remains, except that of the medical group associations, which fear that their organizations will fail to meet standards of timeliness, whatever those may be. The DMHC is continuing to prepare for implementation of the measure and will hold a public meeting on this subject on Tuesday, Sept. 3 in Los Angeles. For details see their website at www.hmohelp.ca.gov.



Anthony E. Wright

Health Access

1127 11th St., #234, Sacramento, CA 95814

Ph: 916-442-2308, Fx: 916-497-0921

awright@health-access.org

Health Access California promotes quality, affordable health care for all Californians.
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