NMHA Supports Patient Protection Legislation

April 6, 2001

NMHA SUPPORTS PATIENT PROTECTION LEGISLATION
Grassroots Push Needed to Reach Goal Line

(Note: For more information on this bill, please see the June 18, June 25, and July 20 alerts)

Background:

Senators Kennedy, McCain and Edwards along with Representatives Dingell and Ganske have introduced a new managed care reform bill that they hope to move through Congress this spring. This new legislation is based largely on the patients’ rights bill sponsored by Reps. Norwood and Dingell (H.R. 2723) that was passed by the U.S. House of Representatives in the previous congress. The new bill, titled “The Bipartisan Patient Protection Act of 2001” (S. 283 in the Senate and H.R. 526 in the House), includes many patient protections of importance to mental health consumers.

Summary:

Access to Emergency Care: Under this bill, health plans would be required to cover emergency care (including emergency psychiatric services) provided to consumers who reasonably believed that immediate medical attention was necessary to avoid serious injury.
Access to Non-formulary Prescription Drugs: The new bill would ensure coverage for prescription drugs (including psychotropic medications) not included on a health plan’s formulary when such non-formulary drugs are deemed medically necessary.
Continuity of Care: The bill would also protect consumers from disruptions in care when a healthcare provider is dropped from a plan’s network or an employer changes healthcare plans. In those instances, consumers undergoing treatment for a serious and complex condition, or a course of institutional or inpatient care could continue receiving care from
a provider no longer covered by that consumer’s healthcare plan for up to 90 days.
Clinical Trials: This bill would require that managed care plans allow consumers with life-threatening or serious illnesses to participate in clinical trials.
Appeals and External Review: The bill would establish criteria and time frames for internal and external appeals that would provide prompt review of coverage disputes. External appeals would be decided by independent physicians or healthcare professionals who are licensed to provide the care at issue.
Scope: These new patient protections would be provided to all consumers covered by group insurance plans and to those with individual insurance arrangements more than 160 million individuals.
Right to Sue: This bill would expand the rights of consumers injured by health care plan coverage denials by allowing them to sue those health plans for full redress of their injuries, including injuries resulting from a failure to treat a mental illness or disease.

The bill’s authors made only two major changes to the Norwood-Dingell legislation:

Liability: The new bill would establish new rules regarding the damages that could be imposed on health plans through a consumer lawsuit. Only federal courts could hear cases involving contract disputes and administrative decisions by a health plan, and punitive damages would be limited to $5 million. Cases arising from a health plan’s medical decisions, however, would be heard in state courts, which could award as much money in damages as state law allows.
Relationship to State Law: The measure specifies that states with comparable patient protection laws could continue enforcing their laws and even enact new laws as long as these state laws establish patient protections comparable to those included in the federal legislation.

NMHA will work to add a provision to prohibit health plans from terminating healthcare coverage for adults with severe mental illness and children with serious mental and emotional disturbances if they fail to comply with their medication regime or miss appointments.

Action Needed:

Patients’ rights legislation has been under active consideration in Congress for several years. NMHA believes that this legislation must be taken up in the House and Senate before August, otherwise both houses of Congress will become distracted by appropriations measures and another year will pass without enactment of these critical patient protections. The Senate bill currently has a total of 18 cosponsors, and the House companion bill has 84 cosponsors (see below). It is likely that a competing bill with far fewer protections will also be introduced. To create momentum for the passage of this strong legislation, many more cosponsors are needed. It is crucial that S. 283 and H.R. 526 receive as much grassroots support as possible! NMHA strongly urges MHAs to call, e-mail, and write members of Congress in support of the Bipartisan Patient Protection Act of 2001 (S. 283/ H.R. 526).

Write: The Honorable _______________, U.S. Senate, Washington, D.C. 20510
The Honorable ______________ , U.S. House or Representatives, Washington, D.C. 20510

Call: The U.S. Capitol Switchboard at 202-224-3121, and ask for your Senator and Representative's office number.

E-mail: Go to Internet site: http://www.congress.org/, type in your zip code and and select "info." You will then be given an option to send a message.

It is especially important for you to write or call if your Senators and Representatives are not listed below.

Senate cosponsors for S. 283

Sen. Max Baucus (D-MT)
Sen. Edward Kennedy (D-MA)
Sen. Jeff Bingaman (D-NM)
Sen. John Kerry (D-MA)
Sen. Lincoln Chafee (R-RI)
Sen. Blanche Lincoln (D-AR)
Sen. Hillary Clinton (D-NY)
Sen. John McCain (R-AZ)
Sen. Jon Corzine (D-NJ)
Sen. Bill Nelson (D-FL)
Sen. Christopher Dodd (D-CT)
Sen. Charles Schumer (D-NY)
Sen. John Edwards (D-NC)
Sen. Arlen Specter (R-PA)
Sen. Bob Graham (D-FL)
Sen. Debbie Stabenow (D-MI)
Sen. Tom Harkin (D-IA)
Sen. Robert Torricelli (D-NJ)

House cosponsors of H.R. 526

Rep. Allen, Thomas H. (D-ME)
Rep. Andrews, Robert E. (D-NJ)
Rep. Baldacci, John Elias (D-ME)
Rep. Barrett, Thomas M. (D-WI)
Rep. Becerra, Xavier (D-CA)
Rep. Berry, Marion (D-AR)
Rep. Bishop, Sanford D. Jr. (D-GA)
Rep. Boswell, Leonard L. (D-IA)
Rep. Boucher, Rick (D-VA)
Rep. Brady, Kevin (R-TX)
Rep. Brown, Sherrod (D-OH)
Rep. Capps, Lois (D-CA)
Rep. Capuano, Michael E. (D-MA)
Rep. Cardin, Benjamin L. (D-MD)
Rep. Clay, Wm. Lacy (D-MO)
Rep. Coyne, William J. (D-PA)
Rep. Crowley, Joseph (D-NY)
Rep. Cummings, Elijah E. (D-MD)
Rep. Davis, Susan A. (D-CA)
Rep. DeFazio, Peter A. (D-OR)
Rep. Dingell, John D. (D-MI)
Rep. Doyle, Michael F. (D-PA)
Rep. Engel, Eliot L. (D-NY)
Rep. Eshoo, Anna G. (D-CA)
Rep. Evans, Lane (D-IL)
Rep. Frank, Barney (D-MA)
Rep. Frost, Martin (D-TX)
Rep. Gilman, Benjamin A. (R-NY)
Rep. Gordon, Bart (D-TN)
Rep. Green, Gene (D-TX)
Rep. Hall, Ralph M. (D-TX)
Rep. Hall, Tony P. (D-OH)
Rep. Harman, Jane (D-CA)
Rep. Hinchey, Maurice D. (D-NY)
Rep. Hoeffel, Joseph M. (D-PA)
Rep. Hoyer, Steny H. (D-MD)
Rep. Jefferson, William J. (D-LA)
Rep. John, Christopher (D-LA)
Rep. Kanjorski, Paul E. (D-PA)
Rep. Kaptur, Marcy (D-OH)
Rep. Kennedy, Patrick J. (D-RI)
Rep. Kildee, Dale E. (D-MI)
Rep. Kleczka, Gerald D. (D-WI)
Rep. Lantos, Tom (D-CA)
Rep. LaTourette, Steve C. (R-OH)
Rep. Leach, James A. (R-IA)
Rep. Levin, Sander M. (D-MI)
Rep. Lewis, John (D-GA)
Rep. Markey, Edward J. (D-MA)
Rep. Matsui, Robert T. (D-CA)
Rep. McCarthy, Carolyn (D-NY)
Rep. McCarthy, Karen (D-MO)
Rep. McDermott, Jim (D-WA)
Rep. McGovern, James P. (D-MA)
Rep. McNulty, Michael R. (D-NY)
Rep. Meehan, Martin T. (D-MA)
Rep. Mink, Patsy T. (D-HI)
Rep. Moakley, John Joseph (D-MA)
Rep. Moore, Dennis (D-KS)
Rep. Morella, Constance A. (R-MD)
Rep. Nadler, Jerrold (D-NY)
Rep. Pallone, Frank, Jr. (D-NJ)
Rep. Pascrell, Bill, Jr. (D-NJ)
Rep. Price, David E. (D-NC)
Rep. Rangel, Charles B. (D-NY)
Rep. Roukema, Marge (R-NJ)
Rep. Rush, Bobby L. (D-IL)
Rep. Sandlin, Max (D-TX)
Rep. Sawyer, Tom (D-OH)
Rep. Slaughter, Louise McIntosh (D-NY)
Rep. Stark, Fortney Pete (D-CA)
Rep. Stenholm, Charles W. (D-TX)
Rep. Strickland, Ted (D-TX)
Rep. Stupak, Bart (D-MI)
Rep. Thompson, Mike (D-CA)
Rep. Thurman, Karen L. (D-FL)
Rep. Tierney, John F. (D-MA)
Rep. Towns, Edolphus (D-NY)
Rep. Turner, Jim (D-TX)
Rep. Udall, Tom (D-CO)
Rep. Waxman, Henry A. (D-CA)
Rep. Weiner, Anthony D. (D-NY)
Rep. Wynn, Albert Russell (D-MD)

For more information, contact Kirsten Beronio, NMHA senior director of Government Affairs, at 703-838-7503 or mailto:kberonio@nmha.org

For more information about the National Mental Health Association and its many programs and activities, visit us at http://www.nmha.org