Presidential vote affects delay
The 2000 presidential elections also play a role in the delay. "Both parties are trying to lay the ground for the upcoming presidential elections, to blame the other side for why legislation didn’t get passed," she says.
However, there has been some legislative activity on the patient rights front. Here are three recent developments:
1. ACEP strongly advocates passage of legislation consistent with the "prudent layperson" standard, which is now law in 26 states.
The standard requires managed care plans to cover emergency services without prior authorization and based on a patient’s symptoms, not his or her final diagnosis. It also was enacted by Congress in the Balanced Budget Act of 1997 as the standard for Medicare and Medicaid patients.
The Roukema-Cardin bill, also known as the Access to Emergency Medical Services Act of 1999, would enact federal standards for the "prudent lay person." ACEP could support any bill that either incorporates the "prudent layperson" language from the Roukema-Cardin bill or, at a bare minimum, follows the Balanced Budget Act language, says Yeh. "In the absence of that, it’s highly problematic."
2. HR 2045, the Patient Right to Emergency Medical Care Act of 1999, was introduced by Rep. Toomey (R-PA).
However, the bill would not adequately protect the rights of patients, Yeh maintains. "It is basically identical to the House-passed bill in the 105th Congress, which ACEP opposed, she says. "It’s worse than the status quo."
The bill does not contain language consistent with the prudent layperson standard. "They use that same terminology, but gutted the true intent," she says. "It is inconsistent with what is already required for Medicare and Medicaid patients."
The language in HR 2045 provides patients with less protection than Congress already provided Medicare and Medicaid patients, Moorhead emphasizes. "The bill is seriously flawed in that it requires patients to meet a new and tougher federal standard for emergency medical coverage," he says. "The language of the bill creates loopholes for endless denials of claims and leaves unclear which services are covered. It also allows managed care plans to make unreasonable charges for cost sharing."