Clinton’s Patients’ Rights Decree on Hold

Last-minute Clinton administration regulations giving Medicaid patients a host of new rights are on hold and under review by the Bush administration, which will be forced to step quickly into the debate over patients’ rights.

The new administration issued a blanket order on President Bush’s first day in office freezing all pending regulations until they can be reviewed. Many of them, including most of the 20 or so regulations now in limbo at the Department of Health and Human Services, involve routine matters of government.

But the new Medicaid rules strike at an ongoing political debate over how much power patients should have in dealing with their insurance companies.

Insurance companies, governors and Medicaid directors are gearing up to lobby the Bush administration for changes.

“We are going to push very hard with the agency to make this better,” said Susan Pisano of the American Association of Health Plans, which represents health maintenance organizations and other managed care plans.

Frustrated at its inability to get legislation through Congress, the Clinton administration set out to extend new patient rights where it could, including health plans for federal workers and in Medicare, the health program for seniors.

In 1998, HHS issued proposed rules for Medicaid, which serves the poor. States, which administer Medicaid, have aggressively moved patients into cost-saving HMOs, which now serve more than half of Medicaid beneficiaries.

After reviewing more than 300 comments submitted on the proposed rules, HHS issued a final version Jan. 18, just two days before President Clinton left office. It was to take effect in 90 days.

The political implications were clear in a statement issued by then-HHS Secretary Donna Shalala. “All Americans--whether they are in Medicare, Medicaid or private health plans--deserve the basic protections that a patients’ bill of rights provides,” she said.

For more than three years, Congress has debated giving patients new power in dealing with cost-conscious HMOs and other managed care plans. But lawmakers have been unable to reach an agreement. Among the disputes: How many Americans should be covered, and whether patients who are harmed should have the right to sue their insurance companies for withholding treatment or other errors.

The Medicaid regulations do not allow for lawsuits, but they do offer numerous other new rights for patients in managed care. Under them, insurance companies must:

* Establish a system for grievances and appeals, including expedited appeals for certain situations, and the right to an independent review.

* Provide patients with comprehensive, easy-to-understand information about how their plans operate, including lists of doctors and hospitals, their phone numbers and addresses.

* Pay for emergency room care, even if it is provided at a hospital outside the network and even if it is not pre-approved, for patients who reasonably believed their health to be in jeopardy.

* Allow women to see gynecologists and other women’s health specialists for routine and preventive services without getting a referral.

* Have enough doctors and hospitals to serve the patients enrolled.

* Submit any marketing materials to the state for approval.

As governor of Texas, Bush supported a state law extending many similar rights to patients and allowed a companion bill allowing for the right to sue to become law without his signature. During the presidential campaign, he said he supported the idea of a patients’ bill of rights, though he did not specify what legislation he would sign.

States and insurance companies hope the new administration will make changes the previous administration would not.

The National Governors Assn. submitted lengthy comments to HHS on its original proposal, said Matt Salo, the NGA’s director of health legislation. “Ninety-nine percent of our comments were ignored.”

In identifying concerns for the new administration, he said: “This ranks absolutely near the top.”

Pisano said increasing government regulations are hampering health plans’ ability to deliver creative services cost-effectively. As an example, she cited a requirement in the new regulation that health plans continuously monitor their compliance with the rules, saying, “That’s something that will sap resources.”

HHS officials had no comment, and there was no immediate response from the White House.