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States Consider Model Managed Care Consumer Protection Bill

States Consider Model Managed Care Consumer Protection Bill

WASHINGTON--State legislators from nine states announced they will introduce the Managed Care Consumer Protection Act when their respective legislatures convene this year. Legislators in others states may also introduce the "model" bill, drafted by a bipartisan group of state legislators. The drafting panel said it sought to avoid piecemeal attempts to resolve conflicts between consumers and managed care plans by drafting a comprehensive, uniform bill.

"The bottom line is that we want to do what's right for consumers," said Tennessee state representative Kathryn Bowers, a Democrat. "We're hoping this bill will give other state legislatures a template for drafting their own consumer protection legislation."

The measure would require plans to (1) provide enough facilities and physicians, including specialists and subspe-cialists, to cover patient needs; (2) ban "gag rules" that forbid providers to discuss all treatment options; (3) have a state licensed physician as medical director; (4) allow patients access to all FDA-approved drugs and devices; and (5) establish appeals and grievance procedures, including the right to appeal plan decisions to a designated state agency.

"This bill can be as valuable to the business of managed care as it is to consumers," said Barbara Wright, a Republican member of the New Jersey Assembly. "Ensuring enrollee satisfaction and quality of care is simply good business."

State legislators from Colorado, Delaware, Georgia, Kansas, New Jersey, Ohio, Oregon, Tennessee, and Texas said they would introduce the bill this year.

The panel that developed the model bill was convened by Women in Government, a nonprofit, bipartisan education association.

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