States continue their push for health-care reform

Pennsylvania state Sen. Timothy F. Murphy, PhD, (R-Allegheny) approaches managed-care reform from two perspectives: psychologist and state legislator. As he worked to push his comprehensive patient-protection bill through the legislature earlier this year, he drew on his background as a practicing psychologist. When other legislators expressed doubts about the existence of 'gag rules,'for instance, Murphy offered to show them contracts he had signed that forbade him to tell patients about more expensive treatment options.

Armed with that firsthand experience, hard data about managed care?s impact and the help of psychologists around the state, Murphy was able to get his Quality Health Care Protection Act passed last June. The legislation includes provisions that outlaw gag clauses, prohibit financial incentives for limiting care and require health plans to pay for emergency care a 'prudent layperson'would deem necessary.

'Managed-care regulation continues to be a real hotbed of activity at the state level,'says Michael J. Sullivan, PhD, assistant executive director for state advocacy in APA?s Practice Directorate.

For the last few years, more than a thousand managed-care bills have been introduced in state legislatures each year, says Sullivan. Now he?s seeing a shift from a piecemeal approach to a more comprehensive attempt to fix the system. Murphy?s bill allowed Pennsylvania to join the 30 states that have passed comprehensive patient-protection laws before this year. Still, some states continue to pass laws focusing on specific aspects of managed care. Some of this year?s highlights are:

? Kentucky and Alaska passed laws banning gag clauses, joining 44 states that have already passed such laws. The six remaining states are working on the issue.

? Indiana and New Mexico became the latest states to pass laws requiring managed-care plans to use the prudent layperson standard when making reimbursement decisions for emergency care.

? Florida, Tennessee and Vermont passed laws giving consumers the right to an independent review of treatment denials.

? Indiana, New Mexico and Tennessee passed laws allowing patients with chronic conditions to use specialists as their primary-care providers. Such laws allow people with chronic conditions to go straight to the provider they need without first getting approval from a gatekeeper.

? Indiana, Virginia and Tennessee passed laws that allow care outside a plan?s network.

? Colorado passed a law prohibiting 'drive-through'baby deliveries, bringing the total number of states with such a law to 43. Fifteen states now prohibit drive-through mastectomies in which mastectomy is treated as an outpatient procedure. All told, 32 states passed 82 laws mandating these and other benefits such as coverage for mammograms, immunizations and diabetes treatment.

'The states are in the forefront on all these issues, and there are no signs that the activity is going to be letting up any time soon,'says Russ Newman, PhD, JD, APA executive director for practice, noting that managed-care reform has become a big issue in at least half a dozen gubernatorial campaigns. 'With so many states already passing laws, it makes it very hard for Congress to duck the issue.'

?Rebecca A. Clay