Stateline Story

States Continue to Endorse Patients' Rights

North Carolina Gov. Mike Easley signed a patient's bill of rights bill into law today (10/18), making his state the 46th to give more legal power to health care consumers. State officials say the new measure is the toughest in the country. Even so, without congressional action on the issue, up to one-third of Americans are not helped by state managed care laws.

That's because most employer-sponsored health plans are regulated by the federal employee Retirement Security Act, or ERISA, and are exempt from the state mandates.

There's no gold standard for a patient's bill of rights, but measures typically require HMOs to tell patients what services are paid for and let women have direct access to an OB/GYN without a referral.

Patients also get the right to air complaints and challenge refusals to pay for care. California was the first state to enact a patient's bill of rights in 1994.

To date,

  • 48 states prohibit health plans from telling doctors what they can and cannot say to patients,
  • 47 states require plans to pay for emergency care,
  • 41 states give women direct access to an OB/GYN, and
  • 40 states have an appeals process for patients to use if they're not happy with a doctor's decision.

North Carolina officials looked at other state laws and pending federal bills before deciding what its bill of rights would look like.

"We extracted the strongest provisions of all the measures and we even added a few new ones," says Alan Hirsch, policy director for Gov. Easley, who unveiled the legislation last February with lawmakers.

Policymakers decided, for instance, to give doctors more say in prescribing drugs. Right now, many health plans restrict drugs they'll pay for by putting them on a list known as a formulary.

Under North Carolina's new law, "if a doctor believes a particular drug is needed by a patient, he has the ability to prescribe it" even if it's not on the formulary, says Hirsch.

Hirsch says in crafting the measure, there wasn't a lot of discussion about potential congressional action. "We're not too terribly concerned that Congress would enact a bill that would lower patient protections. We're reasonably confident our law will stand," he says.

States are concerned about what will happen to laws already on the books, since some congressional proposals will weaken state mandates.

"The federal patients bill of rights is weaker than most of what the states have, and federal lawmakers don't want to invalidate some of the really good stuff states have done," says Rachel Morgan of the National Conference of State Legislatures.

"The biggest impact on states is whether they'll be required to have existing laws certified or whether the feds will grandfather them in," she says.

There are currently two versions of patient protection bills pending in Congress, so it's unclear whether state laws will be grandfathered in or whether they'll have to undergo federal certification. Morgan says full-fledged certification would require the federal government to create a new agency to review what states have done. "It's a guessing game until Congress gets something in black and white," she says.

STATE YEAR ENACTED PROVISIONS
Alaska 1998 Ban on gag clauses, direct access, bans financial incentives
Arizona 2000 Grievance procedures, direct access, experimental treatment
Arkansas 1997 Inpatient care after childbirth, mastectomies, provider credentialing
California 1994 Information disclosure, emergency care services, appeals
Colorado 1997 Consumer grievance process, ER, prescription mandates
Connecticut 1997 Ban on gag clauses, grievance process, medical records, ER
Delaware 1998 Bans financial incentives, grievance process, network adequacy
Florida 1997 Ban on gag clauses, grievance process, data collection, direct access
Georgia 1996, 1999 Disclosure, grievances, confidentiality, independent appeals
Hawaii 1998 Ban on gag clauses, ER care, independent review
Idaho 1997 Direct access, emergency care, out-of-network providers
Illinois 1999 Ban on gag clauses, consumer assistance, emergency care, appeals
Indiana 1998 Ban on gag clauses, grievances, medical records, drug formularies
Iowa 1999 Disclosure, emergency care, independent appeals, report cards
Kansas 1997 Ban on gag clauses, grievance process, ER, direct access
Kentucky 1998, 2000 Grievance process, ER, medical records, direct access
Louisiana 1997 Consumer grievances, financial disincentives, quality assurance
Maine 1996, 2000 Disclosure, reporting, credential, ban gag clauses, ER, experimental treatment
Maryland 1995 Oversight of plans, certification standards
Massachusetts 2000 External review, ER, grievance process, mandated kids mental health services
Minnesota 1997 Ban on gag clauses, disclosure, ER, medical records
Mississippi 1995 Certification standards only
Missouri 1997 Ban gag clauses, data collection, direct access, ER, medical records
Montana 1997 ER, access, provider selection, ban gag clauses, premium rate restrictions
Nebraska 1998 Ban gag clauses, grievance process, ER, network adequacy
Nevada 1997 Ban gag clauses, disclosure, ER, financial disincentives
New Hampshire 1997 Consumer grievance, ban gag clauses, medical records, network adequacy
New Jersey 1997 Ban gag clauses, grievance process, financial incentives
New Mexico 1997, 1998 Ban gag clauses, grievance process, network adequacy
New York 1996 Disclosure, grievance process, direct access, quality of care
North Carolina 2001 Grievance process, Rx formulary
North Dakota 1999 Ban financial incentives, ER, whistleblower protections
Ohio 1997 Consumer grievance process, ER, network adequacy, genetic testing
Oklahoma 1997, 1999 Referrals, ER, ban gag clauses, quality of care, consumer grievances
Oregon 1995, 1997 Consumer grievances, ER, disclosure, network adequacy
Pennsylvania 1998 Ban gag clauses and financial incentives, consumer grievance
Rhode Island 1996 Certification, disclosure, confidentiality, ban gag clauses
South Carolina 1998 Ban gag clauses, disclosure
South Dakota 1999 Network adequacy, quality of care, ban gag clauses, register managed care plans
Tennessee 1998 OB/GYN access, eye care, network adequacy, formularies
Texas 1997 Ban gag clauses, consumer grievance, ER, quality of service
Vermont 1996 Annual review, disclosure, ban gag clauses, quality assurance
Virginia 1995, 1996, 1998, 1999 Appeals, emergency care, ban gag clauses, medical records
Washington 1996, 2000 Disclosure, ban gag clauses, consumer grievance, direct access
West Virginia 2001 Disclosure, financial incentives ban, second medical opinion, grievances
Wisconsin 1998 Emergency care, gag clauses, director certification, experimental treatment

SOURCE: National Conference of State Legislatures

Tags: Health