HHS Announces New Regulations Giving Medicaid Beneficiaries Protections Similar to Those Proposed in Patients’ Rights Bills
The Bush administration on June 13 issued new patients' rights protections for Medicaid beneficiaries in managed-care plans, guaranteeing them a grievance process, access to a second opinion and coverage for emergency care, the Wall Street Journal reports. The new rules were mandated by the Balanced Budget Act of 1997, which allowed Medicaid beneficiaries to join HMOs (Lueck, Wall Street Journal, 6/14). About 58% of Medicaid beneficiaries belong to managed care plans. HHS Secretary Tommy Thompson said the rules would "give Medicaid beneficiaries enrolled in managed care plans the same types of protection that participants in private plans would receive" under patients' rights legislation being considered by Congress. Under the new rule, which is published in the June 14 Federal Register and becomes effective Aug. 13, Medicaid will:
- Pay for emergency room care "whenever and wherever the need arises";
- Allow beneficiaries access to a second opinion (HHS release, 6/13);
- Address beneficiaries' grievances within 45 days, with the possibility of a two-week extension;
- Complete the grievance process in three working days for patients "whose life or health is in jeopardy," with the possibility of a two-week extension (Wall Street Journal, 6/14);
- Allow women "direc[t] access" to a woman's health specialist for routine and preventive health services;
- Not establish restrictions, including "gag rules," that interfere with patient-provider communications;
- Approve marketing materials used by HMOs to enroll beneficiaries and prohibit door-to-door and telephone marketing; and
- Require HMOs to provide beneficiaries with "comprehensive, easy-to-understand information" about the plan.
