Florida’s HMO Citizen Oversight Committees Fall Short of Expectations

A 1996 Florida law that created "statewide citizen committees to investigate patient complaints" against managed care companies is "barely working," due in part to inadequate funding and what patient advocates says is a lack of support from Gov. Jeb Bush's (R) administration, the Orlando Sentinel reports. The law established 11 special "ombudsman" committees to assist patients in HMO disputes, but so far only four are operating in 15 of the state's 67 counties. During the 2000-01 fiscal year, the four committees -- served by volunteer health professionals -- reviewed 758 cases and resolved 351, with 62% of these decided in the patient's favor. But according to advocates, the committees could be far more prevalent and effective if the state Agency for Health Care Administration provided greater support in establishing the committees and lobbying the Legislature and governor for funding. They also say that the managed care industry has helped limit the committees' growth by working to block funding for the program after failing to block passage of the 1996 law. John Rayson, a former Democratic state legislator and sponsor of the 1996 law, said, "AHCA, the governor, the Legislature and certainly lobbyists have not had any keen interest in allowing these committees to become more powerful. Thus far, they've been content to allow it to exist without giving it any muscle."

'Not Keen' on Committees
An upcoming report from the state Senate Health, Aging and Long Term Care Committee "is expected to conclude that ombudsman committees are effective, efficient and deserve funding -- at least in areas where they are up and running," the Sentinel reports. Still, previous attempts by both Republicans and Democrats to fund the committees, which are not reimbursed for travel or phone calls, have proved futile, including a failed request in May to allocate $12,000 of the state's $48 billion budget towards the committees. The law states that AHCA must provide financial support to the committees "within available resources," which the agency says "do not exist." Advocates, however, note that AHCA has never requested money for the program. "This administration is not keen on ombudsman committees. They are more business-friendly, so not too much aid is going to be given or assistance provided," Rayson said.

Creating an Unneeded Tier?
But the governor's office and insurers say that the committees provide a redundant level of patient review already conducted by AHCA and managed care organizations themselves. Rebecca Knapp, head of AHCA's Bureau for Consumer Protection, said, "This is not one of the agency's priorities. HMOs and the state already have legitimate mechanisms in place if a consumer is unable to get care." Lisa Gates, a spokesperson for the governor, said that additional ombudsman committees have not been created due to "little interest to do so in some parts of Florida," adding that Bush "wants to look at how effective the committees have been before deciding to support them." And Robert Brenal, vice president of the Florida Association of Health Plans, said, "There are already external and internal processes in place. Ombudsmen just add one more tier" (Harris, Orlando Sentinel, 8/29). For further information on state health policy in Florida, visit State Health Facts Online.