House Panel Backs MCO Consumer Bill

A bipartisan vote in the US House Commerce Committee has approved newregulation of managed care plans to protect consumers, increasing the likelihood that Congress will create protections for patients who have trouble getting health care coverage.

The changes are in a bill dealing with major revisions to Medicare and Medicaid, slowing the growth of the programs as required by the budget agreement, which is to be discussed in both the full House and the Senate. Among its safeguards of Medicare beneficiaries are that health maintenance organizations must:

- not enforce a gag rule limiting doctors' ability to tell patients about treatments or services; - provide patients with access to specialists when this is "medically necessary in the professional opinion of the treating health care provider" - this will guarantee that insurance clerks cannot deny services a doctor feels are required; - pay for emergency care in any situation that "a prudent lay person" would regard as an emergency; and - allow doctors and patients to make the ultimate decisions on the length of hospital stays.