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President's MessageFlorida Patient Protection Act Of 2000A. Allen Seals, M.D., President |
Patients in Florida are justifiably distressed with their medical care under the current system of HMO managed care; and importantly, have finally captured the attention of their state legislators. As reported in this column last month, multiple managed care reform issues are working their way through the legislative process. Acting as true patient advocates, DCMS and FMA physicians are actively supporting passage of these long overdue improvements to our health care system. Most recently, several of these separate bills (in both the House and the Senate) have been combined to form the "Florida Patient Protection Act of 2000", the first truly omnibus act of Florida legislation to curb some of the well-reported abuses of managed care. The House Bill contains the following provisions (HB 2339): (1) Streamlines certificate of need review processes for introduction of new health care services and exempts certain projects from review; (2) Eliminates 1.5% assessment on outpatient services and increases cap on Medicaid payments for adult hospital outpatient services from $1,000 to $1,500; (3) Prevents health maintenance organization contracts from prohibiting physicians from providing inpatient services to their patients in a contracted hospital; (4) Requires adverse determinations to be made by an allopathic or osteopathic physician and requires notice to patient of reason for denial of care; (5) Creates grant program to address disparities in racial and ethnic health outcomes; (6) Creates Florida Commission on Excellence in Health Care to facilitate development of comprehensive statewide strategy for improving health care delivery systems; (7) Addresses issues relating to insurance coverage available to small employers, repeals existing provisions relating to community health purchasing alliances, and authorizes carrier to issue group policies to small employer health alliances; (8) Solidifies existing patient protection provisions into one section to increase public awareness of protections available in other sections of the law; (9) Requires providers, under contract with a health maintenance organization, to post and prominently display notice of addresses and toll-free telephone numbers of grievance and complaint sections of the health maintenance organizations, the Agency for Health Care Administration, and the Department of Insurance; (10) Revises methodology for small employer health benefit plans; (11) Revises Medicaid eligibility determinations, increases annual outpatient cap, addresses Medicaid fraud issues, provides rulemaking authority, and amends other provisions; and (12) Requires assessment of impact of current mandated health coverages. The Senate Bill contains the following provisions (SB 1900): The bill creates a statutory cause of action for a subscriber against a health maintenance organization (HMO) for actual damages, punitive damages, and attorney's fees, caused by a violation of any of 20 specified subscriber rights. The "rights" are in a list of selected current statutory requirements that apply to HMOs including, among others, requirements that HMOs: (1) ensure that health care services are rendered under reasonable standards of quality of care consistent with the prevailing standards of medical practice in the community; (2) not modify the professional judgment of a physician unless the course of treatment is inconsistent with the prevailing standards of medical practice in the community; (3) not restrict a provider's ability to communicate information regarding medical care options that are in the best interest of the subscriber; (4) provide for standing referrals to specialists for subscribers with chronic and disabling conditions; (5) allow a female subscriber to have direct access to visit an obstetrician/gynecologist; (6) not limit coverage for the length of a stay in a hospital for a maternity or newborn stay, or for a mastectomy, to a time period less than that determined to be medically necessary by the treating physician; (7) not exclude coverage for drugs on the ground that the drug is not approved by the U.S. Food and Drug Administration; (8) not exclude coverage for bone marrow transplant procedures determined by the Agency for Health Care Administration to not be experimental; (9) give the subscriber the right to a second medical opinion; (10) allow subscribers to continue treatment from a provider after the provider's contract with the organization has been terminated; and (11) establish a procedure for resolving subscriber grievances, including the right to an independent external review by a statewide subscriber and provider assistance panel; and (12) provide emergency services and care without prior authorization. The combined efforts of patients and physicians over many years may come to a significant conclusion with the adoption of Florida Patient Protection Act of 2000. The sponsoring legislators should be recognized for their foresight and leadership in promoting these legislative efforts to truly respond to our patients' demands that the current managed care HMO system undergo serious reforms. In addition, the efforts of DCMS and the FMA physicians and staff should also be recognized for providing the political support for this omnibus reform act. As of this writing, this legislation is currently being debated by the Senate and the House. Obviously, both bills have some differences that will need to be resolved, but when this legislation is adopted by the full House and Senate, and signed into law by the Governor, we will witness a significant step forward in the progression of our current health care system. April, 2000/ Jacksonville MedicineWhat's New
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Northeast Florida Medicine Journal ·
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