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Bills to Regulate Managed Care Are Introduced

Bills to Regulate Managed Care Are Introduced

WASHINGTON--Managed care seems a topic certain to generate bipartisan attention during the 105th Congress, with several bills already introduced and others on the way.

Two separate bills aimed specifically against outpatient mastectomies were introduced on the opening day of the new Congress. Three New York Republicans, Sen. Alfonse D'Amato, Rep. Susan Molinari, and Rep. Susan Kelly, introduced the Women's Health and Cancer Rights Act of 1997 in the House and Senate. Rep. Rosa DeLauro (D-Conn) and Rep. Marge Roukema (R-NJ) co-sponsored similar legislation in the House.

Both bills would require health insurers to provide coverage for a minimum of 48 hours following a mastectomy. In addition, the D'Amato-Molinari-Kelly bill would bar the discharge of mastec-tomy patients under any circumstances, and after any amount of time, without the consent of both the patient and her physician, so long as the stay "is medically appropriate."

The bill also guarantees coverage for reconstructive surgery for mastectomy patients and requires insurance coverage of second opinions for all cancers.

Rep. Fortney H. "Pete" Stark (D- Calif), the ranking minority member on the House Ways and Means health subcommittee, introduced a comprehensive bill called the Managed Care Consumer Protection Act of 1997.

Among the provisions of the bill:

  • Plans would have to provide patients and physicians with a written description of utilization review policies, clinical review criteria, and the process used to review medical services.
  • A sufficient number, distribution, and variety of qualified health care providers must be available, including in rural areas, to ensure that all enrollees receive all covered services on a timely basis.
  • A notice to a participating provider of termination or nonrenewal of a contract would have to include reasons for the action.
  • Plans could not use any contractual agreements or written or oral statements "to prohibit, restrict, or interfere with any medical communications between physicians, patients, plans, or state or federal authorities."
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