North Carolina Governor Proposes Patients’ Bill of Rights

North Carolina Gov. Mike Easley (D) on Feb. 20 proposed a state patients' bill of rights that would allow patients to sue their HMOs after completing an external review process and would provide patients with greater access to care and improved benefits, the Raleigh News & Observer reports. Under the proposal, HMO members could appeal denials of care to an independent review panel and then sue in state court for damages, which would not have a cap. The measure also would provide patients "direct access" to pediatricians and "in some cases," specialists. In addition, HMOs would have to cover hearing screening for newborns and "some" clinical trials, and patients in "grave medical circumstances could continue receiving care from their doctor" even if that provider leaves the insurer's network (Gardner, Raleigh News & Observer, 2/21). The measure would also establish an ombudsman's office through the state Department of Insurance to assist managed care consumers, which would help minimize lawsuits, according to state House Majority Leader Phil Baddour (D). A similar bill passed in the state House last year, and state Sen. Allen Wellons (D) said that the measure would likely pass the state Senate (Rice, Winston-Salem Journal, 2/21). Health plan representatives offered mixed responses to Easley's announcement -- which the News & Observer reports "mirrors" the federal McCain-Kennedy patients' rights proposal unveiled earlier this month. While health plans supported provisions to establish a review process and provide direct access to specialists and pediatricians, they said that the right to sue would lead to a large number of lawsuits and drive up overall health care costs. But the National Conference of State Legislatures said that Easley's package was based on similar legislation enacted in Texas, which "has yielded few lawsuits" (Raleigh News & Observer, 2/21).

Blocking the Path
Separately, a North Carolina Senate insurance committee on Feb. 20 passed a proposal that would prohibit the HMO WellPath-Select from dropping patients in 13 counties next month. If enacted, the measure would allow Insurance Commissioner Jim Long to issue a "cease and desist" order against the health plan, requiring it to continue coverage in these counties for at least six months. WellPath, which covers 85,000 North Carolina residents, announced earlier this month that it would drop coverage in 13 counties and continue in nine others, a move that would leave roughly 11,000 teachers and state employees without coverage. State officials contend that WellPath violated state law by canceling coverage for customers who cost more to insure and by dropping them without 180 days notice. The health plan responded that "the company's contract allows it to limit services in counties where it has fewer than 1,000 commercial customers." The Winston-Salem Journal reports that the full Senate will likely consider the bill Feb. 21, and the legislation could reach the House by the end of the week (Damico, Winston-Salem Journal, 2/21).