Negotiators compromise on patients' rights bill

Insurers could pay for hospital stay or care at home for mastectomies

April 10, 1999|By Michael Dresser | Michael Dresser,SUN STAFF

Negotiators for the Senate and House of Delegates reached agreement yesterday on legislation sought by the governor to give significant new rights to members of HMOs and other managed-care insurance plans.

The "patients' bill of rights" is designed to give consumers new flexibility in their health care, with easier access to specialists and a broader choice of medications.

The key to the House-Senate agreement is a compromise giving insurers the choice of paying for a 48-hour hospital stay after mastectomies and testicle removal operations or providing patients with at least one home visit by a care provider within 24 hours. Patients would also be entitled to a second visit at the discretion of the attending physician.

Gov. Parris N. Glendening said the compromise was suggested by Del. Marilyn R. Goldwater, a Montgomery County Democrat, and backed by his administration in a meeting with House leaders Thursday.

Glendening said a woman ought to have the right to 48 hours of medical care after a mastectomy.

"If it turns out that part of that care is at home, I think that is reasonable," he said.

The proposal must be approved by the full House and Senate, but conference committee compromises are seldom rejected.

Both chambers' bills were passed in a weaker form than the legislation originally proposed by Glendening, but legislators of both parties said the governor could claim a victory.

"I think the governor should be very happy with the bill. It certainly delivers the promise that he made," said Sen. Martin G. Madden, a Howard County Republican who served on the conference committee.

The bill gives members of managed-care health plans the right, under certain medical conditions, to have a standing referral under which they can go directly to a specialist for treatment without having to go through a "gatekeeper" for each visit.

The legislation requires health maintenance organizations to reimburse members for visits to physicians who are not in the managed-care network when a patient's condition requires the expertise of an outside specialist.

The bill also requires insurers to help pay for medicines that are not on their list of approved prescription drugs when a physician decides that no medicine on the list is appropriate for the patient's condition.

The compromise on mastectomies and the rarer testicular surgery falls short of the Senate's original position in favor of a required 48-hour stay.

Madden, the Senate minority leader, said the negotiators were mindful of Johns Hopkins Hospital's success with patients having shorter hospital stays after undergoing mastectomies. But he said lawmakers also recognized that not every hospital could match Hopkins' high standard of care.

The compromise based on home visits surprised HMO industry lobbyist D. Robert Enten, who had closely followed the progress of the legislation.

"I have no idea what the financial impact will be. It was never on the table," he said.

The compromise solidifies the role of physicians in providing health care.

Negotiators agreed that only doctors should be primary care providers and that those providers should make referrals only to physicians.

Pub Date: 4/10/99

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