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THE WHITE HOUSE

Office of the Press Secretary

For Immediate Release September 17, 1998

              PRESIDENT CLINTON ANNOUNCES A NEW REGULATION 
             TO BRING THE MEDICAID PROGRAM INTO COMPLIANCE 
   WITH THE PATIENTS' BILL OF RIGHTS AND REITERATES CALL ON CONGRESS 
            TO PASS A STRONG PATIENTS' RIGHTS BILL THIS YEAR
                          September 17, 1998

Today, in a speech before the International Brotherhood of Electrical Workers, President Clinton announced that the Department of Health and Human Services has completed a new regulation to bring the Medicaid program into compliance with the patients' bill of rights. This new proposed regulation -- part of the President's ongoing efforts to institute the patients' bill of rights for all federal health plans -- will provide critical patient protections to millions of Americans served each year by the Medicaid program, including children, people with disabilities, and older Americans. The President also urged Congress to pass a strong patients' bill of rights this year, and criticized the Senate Republican Leadership for failing to bring this important legislation to a vote. Today, the President:

ANNOUNCED A NEW REGULATION TO BRING MEDICAID INTO COMPLIANCE WITH THE PATIENTS' BILL OF RIGHTS. The President announced that the Department of Health and Human Services has completed a new regulation that will give the over 20 million Medicaid beneficiaries in managed care plans the patient protections they need and deserve. This proposed regulation would require managed care plans in all fifty states to provide needed patient protections to Medicaid beneficiaries including:

Access to the specialists they need;

Anti-gag rules to ensure that health professionals can discuss all medical treatment options with their patients;

Access to providers for women's health services;

Access to emergency room services when and where the need arises;

Disclosure of clear, up-to-date information about benefits, plan operations, and protections; and

A timely internal appeals process as well as an independent external appeals to assure patients can address grievances with their health plans.

HIGHLIGHTED THE EXECUTIVE ACTIONS THE ADMINISTRATION HAS TAKEN TO APPLY THE PATIENTS' BILL OF RIGHTS TO TENS OF MILLIONS OF AMERICANS IN FEDERAL HEALTH PLANS. The Medicaid regulation the President announced today is part of his longstanding effort to bring Federal health plans into compliance with the patients' bill of rights. In June, the Department of Health and Human Services extended the patients' bill of rights to Medicare beneficiaries. The Department of Defense, the Department of Veterans' Affairs, and the Office of Personnel Management have issued directives extending similar patient protections to servicemen and women, veterans, and federal employees. Taken together, these executive actions are extending protections to tens of millions of Americans.

UNDERSCORED NEED FOR STRONG LEGISLATION AND URGED THE REPUBLICAN LEADERSHIP TO STOP STALLING AND PASS A BILL THIS YEAR. While the President has acted to ensure that Federal health plans implement the patients' bill of rights, Congress must act to ensure that private health plans give their patients the protections they need and deserve. Just yesterday, the Republican Leadership again refused to allow an up or down vote on the patients' bill of rights. The President urged the Republican Leadership to stop stalling and pass a strong enforceable patients' bill of rights this year.

REITERATED WHY THE ADMINISTRATION CANNOT SUPPORT THE REPUBLICAN LEADERSHIP PATIENTS' BILL OF RIGHTS. The President also reiterated his serious concerns about the shortcomings of the current Republican Leadership bills which:

Let HMOs, not informed health professionals, define medical necessity. The Republican Leadership proposals provide for an external appeals process, but make this process meaningless by allowing the HMOs themselves, rather than informed health professionals, to define what services are medically necessary. This loophole will make it very difficult for patients to prevail on appeals to get the treatment their doctors believe they need.

Fail to guarantee direct access to specialists. The Republican Leadership proposals fail to ensure that patients with serious health problems have direct access to the specialists they need. This means that patients with cancer or heart disease may be denied access to the doctors they need to treat their conditions.

Reverse course on emergency room protections. The Republican Leadership proposals back away from the emergency room protections that Congress implemented in a bipartisan manner for Medicare and Medicaid beneficiaries in the Balanced Budget Act of 1997. The bills include a watered-down provisions that do not ensure coverage for any treatment beyond an initial screening. These provisions put patients at risk for the huge costs associated with critical emergency treatment.

Fail to protect patients from abrupt health care changes. The Republican Leadership bills fail to assure continuity of care when an employer changes health plans. These deficiencies mean that pregnant women or individuals undergoing care for a chronic illness may have their care suddenly altered mid course, potentially causing severe adverse health consequences.

Allow financial incentives to threaten critical patient care. The Republican Leadership proposals fail to prohibit secret financial incentives to providers. This omission would leave patients vulnerable to financial incentives that limit patient care.

Undermine existing medical privacy protections. The House Republican Leadership bill would preempt some existing medical privacy protections guaranteed by state law, without putting protections in their place. As a result, the Republican bill would increase the number of individuals who can review and give out health records without a patient's knowledge or consent.

Fail to compensate patients who have suffered harm as a result of a wrongful health plan action. The proposed per-day penalties in the Republican Leadership plans fail to hold health plans accountable when patients suffer serious harm or even death because of a health plan's wrongful action. For example, if a health plan improperly denies a lifesaving cancer treatment to a child, it will incur a penalty only for the number of days it takes to reverse its decision; the plan will not have to pay the family for all the damages they will suffer as the result of having a child with a now untreatable disease. And because the plan will not have to pay for all the harm it causes, it will have insufficient incentive to change its health care practices in the future.

Do not cover all health plans. Both Republican Leadership bills leave millions of Americans unprotected. The Senate Republican proposal, for example, covers only self-insured plans, thus leaving out more than 100 million Americans, including millions of Americans in small businesses. These Americans are left to hope that states will provide them with the set of patient protections that the Republicans in Congress will not.