House Passes Bill to Assist Md. Patients
By Robert E. Pierre
The Maryland House of Delegates approved legislation yesterday designed to free HMO patients from the need to get repeated referrals to see specialists and give them access to drugs not typically covered by managed-care insurers.
Already a national leader in extending rights to managed-care patients, the measure approved by a 129 to 3 vote has been called this year's "Patients' Bill of Rights." It would allow HMO patients with chronic conditions to revisit specialists without returning to their primary doctor to get a new referral. It also would require a health maintenance organization to pay for a prescription drug not on its approved list if a doctor determined its use was necessary.
A similar bill, approved by the Senate Finance Committee, also requires coverage of a 48-hour minimum hospital stay for mastectomies and testicle removals.
"Our legislation ensures that Maryland consumers have access to the best possible managed-care systems and that health maintenance organizations put patients' rights ahead of corporate profits," Gov. Parris N. Glendening (D) said in a release yesterday.
Insurers and business leaders have warned that the new requirements will simply add to the cost of health care for everyone. Last year, lawmakers required HMOs to submit to an appeals process and to reimburse providers for emergency room care.
Virginia lawmakers approved a similar measure in their legislative session that ended last month. The Virginia legislation creates a managed-care ombudsman to assist policyholders with appeals to health insurers and to demand an independent grievance hearing. The Virginia measure also allows direct access to specialists for long-term treatment.
Many of those things were already in place in Maryland.
"What we did last year with the appeals and grievance process was a huge step forward," said Gerard E. Evans, a lobbyist for Blue Cross and Blue Shield, which operates Maryland's third-largest HMO. This year's reforms, Evans said, were spurred by "rhetoric" from politicians during last fall's campaigns that stirred voter interest.
Health care has been a major topic in recent years, with lawmakers attempting each year to add to patient protections. The House measure approved yesterday also establishes the Maryland Insurance Administration as a clearinghouse for consumer access to health care information. The Senate bill has passed committee but is up for consideration by the full body this week. In addition to a required two-day stay for certain forms of cancer, the Senate bill also requires home visits in some instances.
Any differences in the two bills will be ironed out in a conference committee.
B. Robert Enten, a lobbyist for the Maryland Association of HMOs, said his organization supports many components of the two bills.
"Maryland has been very proactive in passing consumer legislation," Enten said. "This bill codifies many of the practices that already exist in the marketplace."
But HMOs aren't pleased about another measure pending in the legislature that would allow patients to sue HMOs. The measure has failed for the past several years, though it has Glendening's support.
Del. Leon G. Billings (D-Montgomery), who sponsored that measure, said that the right to sue should have been included in Glendening's package.
"The governor's bill doesn't go far enough," said Billings, contending that the grievance process is too cumbersome and will be used little.
Billings is supported by the state's medical society, which contends that medical directors ought to be held to the same standard as doctors, who can be sued for malpractice. Glendening supports the measure. But Evans said it is unreasonable.
"That's way beyond rational," Evans said. "We don't provide care. We're the umpire. We don't say to a doctor, `Don't do this.' We might say it's not covered. But the care of patients is in the hands of physicians."
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