Ensure Patient Access to Responsible Care in Managed Care
Plans Similar to Last Year's PARCA Bill (H.R.
The ACA is part of a broad coalition of
health care groups and consumer organizations, known as the
PARCA coalition, which have joined together to seek the
passage of a comprehensive package of federal legislative
reforms which would establish national standards to ensure
patient choice of provider and improve quality in health
plans, including managed health care plans.
||Many versions of
managed care reform legislation have been introduced in
Congress this year including:
- The Access to Quality Care Act (H.R. 216) introduced by
Representative Norwood (R-GA) with 14 cosponsors;
- The Patients' Bill of Rights (S. 6/H.R.358) introduced
by Senator Daschle (D-SD) and Representative Dingell (D-MI)
with 31 cosponsors in the Senate and 173 in the House.
- House and Senate Republican Leadership bills (S.
300/H.R. 448) introduced by Senator Majority Leader Trent
Lott (R-MS) and Representative Michael Bilirakis (R-FL) with
49 cosponsors in the Senate and 12 in the House (including
the Speaker and Majority Leader).
|None of these bills
have all the principles endorsed by the ACA and the PARCA
coalition. Any final legislation should contain:
- Pro-competition provisions, which prevent managed care
plans from discriminating against health care providers
based solely on licensure or certification and allow
patients' access to appropriate care;
- A meaningful point-of-service provision, which ensures
patients' freedom to select providers of their choice,
including the ability to access out-of-network providers;
- Patient and provider rights to due process to appeal
adverse coverage decisions.
- America's health care delivery system is now dominated
by managed health care and self-insured health plans. All
too often, these plans deny the patient choice of provider
and through a system of positive and negative financial
incentives, deny necessary health care to plan enrollees.
- States, which have traditionally set standards to
protect both consumers and providers in health and insurance
plans, have little ability to ensure quality and choice of
provider, because the vast majority of managed care plans
escape state regulation through a loophole -- the federal
Employee Retirement Income Security Act (ERISA) statute.
ERISA not only preempts state authority but provides no
comparable set of standards to protect patients and
providers at the federal level. Legislation should provide a
comprehensive set of legislative protections which would
allow for state enforcement where possible, and for federal
enforcement when state enforcement is not possible.