Bills to Regulate Managed Care Are Introduced

WASHINGTON--Managed care seems a topic certain to generate bipartisanattention during the 105th Congress, with several bills already introducedand others on the way.

Two separate bills aimed specifically against outpatient mastectomieswere introduced on the opening day of the new Congress. Three New YorkRepublicans, Sen. Alfonse D'Amato, Rep. Susan Molinari, and Rep. SusanKelly, introduced the Women's Health and Cancer Rights Act of 1997 in theHouse and Senate. Rep. Rosa DeLauro (D-Conn) and Rep. Marge Roukema (R-NJ)co-sponsored similar legislation in the House.

Both bills would require health insurers to provide coverage for a minimumof 48 hours following a mastectomy. In addition, the D'Amato-Molinari-Kellybill would bar the discharge of mastec-tomy patients under any circumstances,and after any amount of time, without the consent of both the patient andher physician, so long as the stay "is medically appropriate."

The bill also guarantees coverage for reconstructive surgery for mastectomypatients and requires insurance coverage of second opinions for all cancers.

Rep. Fortney H. "Pete" Stark (D- Calif), the ranking minoritymember on the House Ways and Means health subcommittee, introduced a comprehensivebill called the Managed Care Consumer Protection Act of 1997.

Among the provisions of the bill:

• Plans would have to provide patients and physicians with a writtendescription of utilization review policies, clinical review criteria, andthe process used to review medical services.
• A sufficient number, distribution, and variety of qualified healthcare providers must be available, including in rural areas, to ensure thatall enrollees receive all covered services on a timely basis.
• A notice to a participating provider of termination or nonrenewal ofa contract would have to include reasons for the action.
• Plans could not use any contractual agreements or written or oral statements"to prohibit, restrict, or interfere with any medical communicationsbetween physicians, patients, plans, or state or federal authorities."