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The fight for patients' right to sue managed-care
firms seems headed for a showdown.
BY JOE VOLZ
Monitor staff
APA played a key role last year in the passing
of a landmark House bill allowing injured patients to sue
managed-care companies for negligence.
But the war hasn't been won yet.
The corresponding Senate bill does not give
patients any such right. Differences between the two bills
will have to be ironed out in a House-Senate conference this
spring.
Dave Nelson, APA's director of federal
advocacy, says the main patient-protection item on APA's
legislative agenda right now is to convince conferees to agree
on the House liability provision that alters the Employee
Retirement and Income Security Act of 1974 (ERISA). That law
bars negligence suits by plaintiffs in state courts.
Supporters of making managed-care firms liable
contend that health insurers should not be shielded from state
laws.
The House bill permits suits in state courts
to recover damages resulting from personal injury or from
wrongful death. The bill prohibits insurers from retaliating
against a patient or provider based on that individual's use
of the appeals process.
Normally, a conference of House and Senate
members, who presumably represent the views of their
respective legislative bodies, attempts to hammer out a
compromise.
But Nelson says it is going to be an uphill
battle because "the House Republican leadership stacked the
conference committee with House members who are adamantly
opposed to the liability provision."
In other words, House leaders who lost the
fight against the House bill on the floor are hoping to block
the negligence issue in the conference room.
Nelson says that, in addition, "the
managed-care industry mounted an intense advertising lobbying
campaign recently, warning that employers would face increased
liability if accountability became law. APA has taken the lead
in countering this claim by pointing out that the House bill
protects employers from being sued for negligent care,
provided the employer is not directly involved in
decision-making about benefit claims in a way similar to a
health-care professional, hospital or health plan, Nelson
says.
Marilyn Richmond, assistant APA executive
director for government relations, says the Practice
Directorate plans to use the same advocacy tactics that were
successful in the passage of the House bill last year.
"Support for the bill involved thousands of
calls from psychologist-constituents to their members of
Congress, fly-ins to Washington, D.C., for meetings between
practitioners and key congressmen and, more locally,
psychologist participation in town hall meetings," she says.
Meanwhile, APA is pursuing other priorities on
Capitol Hill:
Mental Health Parity: Action is
expected this year on two mental health parity bills before
Congress. The House bill, sponsored by Rep. Marge Roukema
(RN.J.), would provide full parity in insurance coverage
for mental health and substance abuse services, including
inpatient days and outpatient visiting. But the Senate bill
sponsored by Sens. Pete Domenici (RN.M.) and Paul
Wellstone (DMinn.) requires full parity only for
designated "severe biologically based mental illnesses" such
as schizophrenia, bipolar disorder and major depression. APA
continues to advocate for full parity not restricted to
specific mental disorders.
Confidentiality: Federal legislators
missed the deadline last August to enact patient
confidentiality standards as required by the Health Insurance
Portability and Accountability Act of 1996. Now, Congress
wants new regulations written this year. Proposed regulations
specify that psychotherapy notes may not be shared without the
patient's consent. APA's Practice Directorate has consistently
advocated that patient records must be protected through
comprehensive requirements regarding confidentiality.
Medicare Graduate Medical Education
Funding: The Health Care Financing Administration intends
to propose a rule that would include psychology among health
professions eligible for Medicare Graduate Medical Education
funding.
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