States Consider Model Managed Care Consumer Protection Bill

WASHINGTON--State legislators from nine states announced they will introducethe Managed Care Consumer Protection Act when their respective legislaturesconvene this year. Legislators in others states may also introduce the"model" bill, drafted by a bipartisan group of state legislators.The drafting panel said it sought to avoid piecemeal attempts to resolveconflicts between consumers and managed care plans by drafting a comprehensive,uniform bill.

"The bottom line is that we want to do what's right for consumers,"said Tennessee state representative Kathryn Bowers, a Democrat. "We'rehoping this bill will give other state legislatures a template for draftingtheir own consumer protection legislation."

The measure would require plans to (1) provide enough facilities andphysicians, including specialists and subspe-cialists, to cover patientneeds; (2) ban "gag rules" that forbid providers to discuss alltreatment options; (3) have a state licensed physician as medical director;(4) allow patients access to all FDA-approved drugs and devices; and (5)establish appeals and grievance procedures, including the right to appealplan decisions to a designated state agency.

"This bill can be as valuable to the business of managed care asit is to consumers," said Barbara Wright, a Republican member of theNew Jersey Assembly. "Ensuring enrollee satisfaction and quality ofcare is simply good business."

State legislators from Colorado, Delaware, Georgia, Kansas, New Jersey,Ohio, Oregon, Tennessee, and Texas said they would introduce the bill thisyear.

The panel that developed the model bill was convened by Women in Government,a nonprofit, bipartisan education association.