COMMENT: Implicit in the below is continuing and everpresent mistake that somehow your Rights emanate from the State. It so very generous of our government to give us that which we are already entitled to and should have the right to sue for except for that right being eroded by our government. =================================================================== President Clinton Gets Back Into the Health Care Fray Authors: Clare Richardson, JD, Robyn A. Meinhardt, JD, Paula C. Ohliger, JD [Drug Benefit Trends 10(3):22-23, 1998. © 1998 SCP Communications, Inc.] Introduction In his State of the Union address on January 27, President Clinton urged Congress to adopt the Consumer Bill of Rights and Responsibilities ("Bill of Rights") issued last November by the Advisory Commission on Consumer Protection and Quality in the Health Care Industry ("Commission"). The Commission was appointed by the President in March 1997 to "advise the President on changes occurring in the health care system and recommend measures as may be necessary to promote and assure health care quality and value, and protect consumers and workers in the health care system." The President had asked the Commission to develop a health care Bill of Rights and to provide him with recommendations to enforce those rights at the federal, state, and local level. The Commission's final report is due to the President by March 30, 1998. The Bill of Rights contains 8 areas of consumer rights and responsibilities: information disclosure; choice of providers and plans; access to emergency services; participation in treatment decisions; respect and nondiscrimination; confidentiality of health information; complaints and appeals; and consumer responsibilities. Information Disclosure The Bill of Rights states that consumers have the right to receive accurate, easily understood information and, when required, assistance in making informed decisions about their health plans, health care professionals, and treatment facilities. Consumers should receive information about health professionals and health care facilities in addition to health-plan information including benefits, cost-sharing, and dispute resolution; plan characteristics and performance; network characteristics; and care management. Consumers should also be advised that information is available regarding health plans, health professionals, and health care facilities--and they should be told how it can be obtained. Choice of Providers and Plans The Bill of Rights states that consumers should be able to choose high-quality health care providers. To ensure such choice, the Commission asks for: * network adequacy; * greater access to qualified women's health specialists; * easier access to specialists for consumers with complex and serious conditions; and * greater continuity of care for consumers who enroll in new health plans or see their provider dropped from a plan for reasons other than cause. Access to Emergency Services Consumers should have the right to access emergency health care services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a "prudent lay person" could reasonably expect the absence of medical attention to place that consumer's health in serious jeopardy or to cause serious impairment to bodily functions or serious dysfunction of any body organ or part. The Balanced Budget Act of 1997 already requires health plans participating in the Medicare or Medicaid programs to reimburse for emergency services using a "prudent lay person standard." Although numerous states have adopted this standard for access to emergency services, the Commission seeks to have all states adopt uniform standards. Confidentiality of Health Information The Bill of Rights states that consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information protected. Consumers also have the right to review and copy their own medical records, as well as the right to request amendments to their records. Although confidentiality is ensured by existing federal and state laws, the Commission wants to ensure that individually identifiable health care information would be used without written consent for health purposes only and that such disclosure would be permitted only in limited circumstances in which there is a clear legal basis for disclosure. Complaints and Appeals Consumers should have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. Internal and external complaint and appeal processes should be: * timely; * administratively simple; * objective and credible; * accessible and understandable to consumers; * cost- and resource-efficient; and * subject to quality review. The Commission acknowledges that group purchasers, health plans, and provider organizations are already subject to numerous federal and state laws and that most are subject to standards of private accrediting bodies--and the Commission adds that it doesn't intend to weaken any existing consumer protections. Consumer Responsibilities In a health care system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities, according to the Bill of Rights. Greater individual involvement by consumers in their care increases the likelihood of achieving the best outcomes and helps support a quality-improvement, cost-conscious environment. Although the Commission believes that individual consumers must assume certain responsibilities, the Commission does not intend to create a link between an individual's conduct in meeting those responsibilities and the obligations of health plans and providers to provide covered services. Impact The Bill of Rights is advisory only and does not contain any provisions governing implementation and enforcement. To the extent that its provisions are already state and federal mandates, health plans, consumers, and providers are, of course, obligated to comply. Otherwise, the Bill of Rights is to serve as a guide for health plans, providers, and consumers in shaping their health care decisions in cases for which procedures are not yet in place--and it may well be important in framing future policy debates about consumer rights in Congress and in state capitals. The most controversial aspect, and the one that MCOs least want to see enacted into law, involves patient freedom of choice. About the Authors Ms. Richardson and Ms. Meinhardt are partners in the Los Angeles office and Ms. Ohliger is an associate in the San Francisco office of Foley & Lardner, the nation's 10th largest law firm, which has a nationally recognized health care practice. Portions of this article were published in LawWatch, a legal newsletter from Foley & Lardner, December 9, 1997, Volume 97-25. Note: At press time, an Executive Memorandum was issued that directs all federal health plans to comply with the Consumer Bill of Rights by no later than next year. COMMENT: Apparently, the Executive branch of the Federal Government of the USA has dispensed with the Congress as maker of law; we now law by "Executive Edict" and the sheep of the USA swallow this simply because they don't know any better.