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."