Oregon Enacts Managed Care Liability Law, Massachusetts Continues Debate Over Unlimited Managed Care Malpractice Damages
Oregon Gov. John Kitzhaber (D) signed a bill (HB 3040) last week that creates a "limited" right for patients to sue their health plans, the Portland Oregonian reports. The new law will take effect July 1, 2002, and will allow patients to have an "impartial" state-certified expert review denied claims. The law also allows patients to sue their insurer if the plan does not submit to an external review. In addition, plans that do not adhere to the decisions of an independent review will face fines starting at $100,000 per offense and may also be sued. Plans that "exaggerate" the number of doctors available to members will face unfair trade penalties. The law gives patients the right to continue care with a physician for up to 120 days if the doctor leaves the plan's network, provided the patient is receiving "active treatment," and to receive a second opinion in cases of denied referrals. The law also directs the Department of Consumer & Business Services to issue "uniform measures" for consumers to compare doctor and hospital networks used by managed care plans. When signing the law, Kitzhaber said it was "an important step toward ensuring that certain people who have coverage can be confident that the system is truly responsive to their needs" (Burke, Portland Oregonian, 5/31).
Massachusetts Bill Gains Momentum
A Massachusetts bill that would allow patients to win "unlimited malpractice damages" from health plans has picked up key support, as state Sen. Richard Moore (D), chair of the state Senate Committee on Health Care, announced his support for the measure, the Springfield Union-News reports. Currently, Massachusetts caps HMO malpractice liability at $20,000; the bill would remove that limit and require HMOs to "demonstrate their financial health to the state." However, Harvard Pilgrim Health Care President and CEO Charles Baker warned that the bill would increase premiums in the state by 2%-4% (Lauerman, Springfield Union-News, 5/31).
