Nine US States Plan Managed Care Act

A bipartisan group of US state lawmakers has drafted the Managed CareConsumer Protection Act, which sets quality standards for managed care plans in the hope of avoiding what they term "piecemeal" attempts to place consumer standards on the industry.

The bill, to be introduced in New Jersey, Texas, Colorado, Georgia, Delaware, Kansas, Ohio, Oregon and Tennessee, was developed by a panel convened by a nonprofit educational association, Women in Government, which says it aims to strike a balance between patients and business.

The model bill provides safeguards for enrollees on specific issues, eg access to medical specialists, grievance procedures, choice of provider, quality of care based on clinical outcomes, criteria for covering experimental drugs and treatments, and ensuring that licensed doctors not business personnel set treatment policies. It includes no specific mandates on what plans must cover but does set general requirements, some of which run counter to common cost-cutting measures used by managed care companies.