Minnesota AG outlines new healthcare legislation

Hatch lays out health care objectives for 2002 legislative session

Patricia Lopez

Star Tribune

Published Jan 18 2002

http://www.startribune.com/stories/462/1107092.html

Minnesota Attorney General Mike Hatch said he will attempt to resurrect health care legislation during the coming session that would make dramatic changes in how health maintenance organizations do business.

The legislation, which passed in the state Senate in 2000 but did not get a hearing in the House, would guarantee patients a second opinion any time they are denied coverage.

It also would allow them to sue their HMO in court, Hatch said, provided they met several tests that include a proof of harm to their health as a result of denied coverage recommended by their doctor.

In addition, Hatch said, HMOs no longer would be the sole arbiters of what is considered "medically necessary," but instead would have to submit to an objective standard devised by the medical community.

HMOs that denied coverage would have to make the reviewer who made the decision available by phone to the patient, to offer reasons for the denial.

The "Fairness in Health Care Act" also would bar HMOs from changing their decision once they gave preauthorization for treatment.

Another problem that frequently bedevils patients, Hatch said, is that they never receive a copy of their actual policy. A copy is supposed to be available from the employer, Hatch said, but often is not. The legislation would require HMOs to make policies available before consumers buy coverage.

In addition, if a patient needed a specialist, Hatch said, and none was available in the HMO network, he or she must be allowed to go outside the network. The cost, he said, could not exceed what the patient would have paid inside the network.

A separate drug pricing act, which also passed the Senate, he said, would lower the cost of prescription drugs by requiring pharmaceuticals to rebate 11 percent to 15 percent of the drugs they sell. Rebates might be significantly higher on certain drugs, Hatch said.

Critics of the health care proposal have said the changes sought would further boost the price of health care, while the forced rebates might reduce the incentive to bring new, costly drugs to market.

-- Patricia Lopez is at [email protected] .