White House Order Prescribes More Power For HMO Patients

      WASHINGTON - The Clinton administration will soon issue new rules to give patients the ability to challenge decisions made by managed-care organizations.

      The administrative rules, expected to be finalized by the end of the year, would require health maintenance organizations to respond quickly to complaints or run the risk of litigation.

      The new regulations, first proposed in 1998, do not go as far as the patients'' bill of rights legislation under debate in Congress. But they have earned the ire of HMOs and independent businesses opposed to reform measures.

      President Clinton''s executive powers are limited by the 1974 Employee Retirement Income Security Act, which restricts lawsuits against health-care plans to federal courts and generally limits damages to the cost of denied care.

      The proposed rules would give managed-care companies 15 days to respond to a claim for benefits, and 30 days for an appeal. Patients would be given the right to access their records; they would receive specific reasons for a denial; and they would be allowed an independent review before an appeals claim could be denied.

      Managed-care groups and businesses say the paperwork alone would drive up the cost of health care so drastically that fewer people would be able to afford coverage.

      ``A few weeks before the election, they want to ram this through in a blatant attempt to win votes,'' complained Mary Crawford, spokeswoman for the National Federation of Independent Businesses.

      But administration officials say the timing is not only apolitical, it''s the result of nearly three years of negotiations with the health-care industry.

      ``We have heard so much testimony on the compelling need for this regulation, I would really hate for it to get caught up in politics,'' said Leslie B. Kramerich, an acting assistant secretary for the Labor Department''s Pension and Welfare Benefits Administration.

      She said the administration received more comments on the proposed rules, which were published in the Federal Register in September 1998. The rules to be finalized, she said, stem from recommendations made by a commission that studied patients'' complaints throughout 1997.

      Horror stories about patients being denied care by their HMOs prompted Clinton to create the commission. But he also has pushed a patients'' bill of rights.

      Polls show voters keenly interested in seeing an HMO reform measure, prompting congressional Republicans and Democrats to push for change.

      A bipartisan proposal named for Reps. Charlie Norwood, R-Ga., and John Dingell, D-Mich., passed the House, 275-151, last October with support from 68 Republicans. The bill would permit patients to sue in all state courts and claim significant damages.

      One week later, the Senate passed a similar bill, with a weaker right-to-sue provision.

      Intense lobbying by insurance companies and managed-care organizations derailed progress, leaving one of the year''s hottest political issues languishing in a conference committee.

      But Republicans who would like to bring a patients'' bill of rights home to voters for their re-election campaigns said Tuesday they are still trying.

      ``This debate has sadly been characterized by extremes on both sides,'' said Rep. John Shadegg, R-Ariz. He said the House Republican leadership has charged him with coming up with a compromise.

     

c. 2000 Houston Chronicle