New Jersey Law Creates Ombudsman Program for Managed Care Patients

Shortly before leaving office last week, former New Jersey Gov. Christine Todd Whitman (R) signed a new state HMO consumer help bill (A 1088) into law, creating an "ombudsman program" for managed care consumers, the Bergen Record reports. Two not-for-profit agencies -- the Community Health Law Project in the northern half of the state and New Jersey Protection and Advocacy Inc. in the southern half -- will receive a combined total of $500,000 in state funds to ensure managed care customers get "the coverage to which they are entitled" and to educate patients about their rights. The Record calls the law "part of a series of HMO consumer protection measures" enacted under Whitman, who left her post to head up the Environmental Protection Agency. The Record adds that the trend could continue under acting Gov. Donald DiFrancesco (R), who in August, while acting as state Senate president, introduced an 18-law reform package that included a right-to-sue measure holding HMOs responsible for decisions harmful to members' health. Members of the HMO industry expressed skepticism over the efficacy of ombudsman programs, noting that many complaints are already handled by state regulators or industry appeals programs. "It's more cost and more work, and I'm not sure consumers will get any significant benefit," Christy Bell, senior vice president of Horizon Blue Cross and Blue Shield of New Jersey, said.

Efforts in Other States
A "handful" of other states have instituted ombudsman programs that, often "underfunded and underpublicized," have achieved mixed results. Florida's consumer agency, created by a law passed in 1998, operated with a volunteer staff and no state funding before being dismantled last year. Massachusetts in 1999 appointed a state HMO ombudsman, but failed to advertise the service. Vermont's program, the most similar to New Jersey's, handled 1,775 calls in its first year, with access to dental care and prescription drugs the most common complaints. Funding for New Jersey's program will increase to $800,000 next year (Washburn, Bergen Record, 2/3). To view the bill, go to http://www.njleg.state.nj.us/2000/Bills/a1500/1088_r2.htm. Note: You must have Adobe Acrobat to view it.