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AIF PROPOSES HMO PATIENT PROTECTION ACT OF 2000

March 3, 2000

TALLAHASSEE--  Today, Associated Industries of Florida (AIF) released its Patient Protection Act of 2000. The legislative proposal was developed on behalf of Florida's employers, employees, and their families, to protect and ensure their access to quality and affordable health care in Florida.

A number of anti-HMO bills have already been filed for the 2000 session, the most dangerous of which, from the business community's perspective, is the so-called Patients' Bill of Rights. The AIF bill was developed in response to the attacks on the state's managed care system. Its main features are steps to codify the state's existing HMO consumer protection laws and to beef up the appeals process for HMO subscribers.

"The patients' bill of rights legislation has little to do with protecting patients and everything to do with ruining HMOs' ability to control the costs of health care," said Jon L. Shebel, AIF's president & CEO. "The goal of AIF's legislative proposal is to improve the climate for everyone involved, not destroy it."

Many Florida employers have seen double-digit increases in their health insurance this year and no relief is in sight in the immediate future. Rising premium costs are coming at a time when the numbers of uninsured are also beginning to grow.

"Most Floridians who enjoy private insurance receive it through their employers," said Shebel. "Protecting access to affordable health care is based on more than concern for workers. It's a bottom line issue for us."

Shebel took issue with the negative picture of HMOs painted by the trial lawyers'

media campaign. "You don't hear the stories about how HMOs are improving the lives of the chronically ill," he noted. "You don't read stories about the studies showing that HMOs provide better treatment outcomes for patients."

AIF is responding with a public information campaign to inform Floridians about the impact of anti-managed-care legislation on their health insurance. The campaign will run during the session and up to the November elections.

AIF's legislative proposal also includes funding for a public information campaign run by the Florida's Agency for Health Care Administration (AHCA) to spread the word about the state's process for resolving managed care coverage disputes. "Only trial lawyers want to resolve these disputes with lawsuits," said Shebel. "A medical malpractice claim takes, on average, 54 months to resolve. We've already got an appeals process in place that can resolve a dispute in 48 hours and we're proposing other patient-friendly options to resolve disputes. The problem seems to be that nobody knows about it."

Associated Industries is a statewide employers association representing more than 10,000 businesses who collectively employ more than 1 million people. Member companies range from large multinational corporations to small family-owned enterprises. AIF is commonly known as "The Voice of Florida Business."

For a full copy of AIF's HMO Patient Protection Act of 2000, contact Dwight Sumners, AIF vice president – corporate communications, at (850) 224-7173 or by e-mail at dsumners@aif.com.


 
EXECUTIVE SUMMARY: HMO PATIENT PROTECTION ACT 2000 
  • HMO Patient Bill of Benefits
    This legislation clearly identifies the principles of consumer protection that the laws afford HMO patients. Florida consumers can expect high standards of quality care, ready access to specialists, confidence in the financial solvency of their health plan, continuity of care when their doctor leaves a panel or the patient changes insurers, and an inexpensive, efficient manner of resolving complaints.
  • Medical Doctors Must Make Treatment Coverage Decisions
    This legislation mandates HMOs use only licensed medical doctors in denying coverage for treatment which requires medical judgement and training. Denials will be based on the treating physician's failure to meet prevailing medical standards of care.
  • Mandatory External Review of Medical Necessity Decisions
    All patients currently have the right to appeal HMO decisions to an internal review process. This proposal creates the right of patietns to access an external panel of medical experts outside the HMO if the HMO disagrees with the medical necessity of a particular treatment.
  • Strengthening the State Panel for Patient Appeals
    Since approximately half of the disagreements that come to the Statewide Subscriber Assistance Panel are related to disputes over the terms of the patient's contract, this provision adds an attorney specializing in contract law to the panel.
  • Currently, the HMO can appeal decisions of the panel to the administrative hearing process; however, the member is limited to seeking redress in the courts. This provision affords the patient the right to an administrative appeal also.
  • Public Awareness and Assistance for HMO Patients

    The state will undertake a statewide awareness program of the protections afforded Floridians. A consolidated "Hot Line" for electronic and telephone access for all complaints and inquiries will empower citizens to better protect themselves when they have health care needs. Part of this program mandates all managed care organizations, health care facilities and physicians post signs advertising this service to patients.

  • Protecting the Patient from Unwarranted Billings
    This provision clarifies that physicians and other providers cannot send bills to patients or subject those patients to collection agencies when those patients are HMO subscribers receiving covered services.
  • Mandated Health Benefits
    This provision establishes a formal, actuarially based process for the legislature to use when expanding the health benefits that must be purchased by Floridians. Also, it allows small employers to choose health benefits of their choice without state mandates.