ACP-ASIM Supports Consensus Managed Care Improvement Act of 1999
May 24, 1999
College Suggests Adding Language on Medical Necessity
(Washington, DC): The American College of Physicians - American Society of Internal Medicine has announced its support for the Consensus Managed Care Improvement Act of 1999. The legislation, sponsored by Congressmen Charles Norwood (R-GA) Tom Coburn (R-OK), would provide patients with rights and protections in managed care health plans.
"This legislation will help ensure that medical decisions on based on a patient's best interests, not the financial interests of a managed care company," said ACP-ASIM Associate Executive Vice President Alan Nelson, MD, FACP. "It establishes the kind of accountability that is crucial to maintaining quality in the health care system."
The ACP-ASIM has urged the Commerce Committee to act favorably on the Norwood bill, although it plans to seek improvements in the legislation as it moves through the legislative process. For example, the College has suggested including language that defines medical necessity as a service or benefit "which is consistent with generally accepted principles of professional medical practice" for the initial determination, as well as for all subsequent appeals.
"Such language is needed to prevent insurers from arbitrarily denying needed care," said Dr. Nelson.
The College specifically commended the legislation's provisions for:
- Meaningful internal and external grievance and appeals procedures.
- Direct access to specialty care when clinically indicated.
- Recourse in the courts when a patient is harmed because of an arbitrary denial of care.
- A prudent layperson standard to govern determinations on emergency care.
- Continuity of care for patients with chronic conditions if their physician is dropped from a plan.
- Provisions to make the standards applicable ERISA and non-ERISA plans.
- A ban on "gag rules" that restrict physician-patient communication.
ACP-ASIM is the nation's largest medical specialty organization, and the second largest physician group. Membership comprises more than 115,000 internal medicine physicians and medical students. Internists are the major providers of medical care to adults in America.
Jack Pope (202) 261-4556
Page updated: 11-04-03