FOR IMMEDIATE RELEASE, Contact: (202) 225-3943
April 16, 1998
No. HL-21
Congressman Bill Thomas (R-CA), Chairman, Subcommittee on Health of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on how patient appeals are processed in various health care settings. The hearing will take place on Thursday, April 23, 1998, in the main Committee hearing room, 1100 Longworth House Office Building, beginning at 10:00 a.m.
Witnesses will include representatives from the Health Care Financing Administration (HCFA), health insurance and managed care organizations, and patient advocacy groups. Any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing.
BACKGROUND:
Due process is a core value of the American legal system and has recently become an important health care issue. Virtually all private and public health organizations provide consumers with some form of complaint resolution, using varied procedures to respond to consumer complaints.
With respect to the Medicare appeals process, a U.S. District Court in Arizona in 1997 found that HCFA (and the Medicare HMOs with which HCFA contracts) denied beneficiaries their right to fair notice and hearings in contesting coverage issues. The court ordered HCFA to provide seniors with detailed information concerning grievances, hearings and appeals.
Many States require health insurers to provide certain complaint procedures. More than thirty States have some specific complaint procedures that health plans must follow. A growing number of States are also requiring expedited appeals for denials of urgently needed care.
In announcing the hearing, Chairman Thomas stated: "Patients should be assured that they have an avenue for appealing health care decisions and that these decisions are made in a timely manner. While concerns have been raised about current regulations, in fact, many insurers and health care organizations are already going beyond the requirements of existing State and Federal law. Patient satisfaction in resolving disputes is a key element for maintaining confidence in the American health care system."
FOCUS OF THE HEARING:
The Subcommittee will examine the different types of appeals procedures used in Medicare and in private markets, and what progress HCFA has made in improving patient appeals. In addition, the Subcommittee will consider lessons learned from States which have traditionally regulated health insurance benefits. A representative of the National Association of Insurance Commissioners (NAIC) will testify regarding its model grievance statute which is under consideration in a number of States.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Any person or organization wishing to submit a written statement for the printed record of the hearing should submit at least six (6) single-space legal-size copies of their statement, along with an IBM compatible 3.5-inch diskette in ASCII DOS Text or WordPerfect 5.1 format only, with their name, address, and hearing date noted on a label, by the close of business, Thursday, May 7, 1998, to A.L. Singleton, Chief of Staff, Committee on Ways and Means, U.S. House of Representatives, 1102 Longworth House Office Building, Washington, D.C. 20515. If those filing written statements wish to have their statements distributed to the press and interested public at the hearing, they may deliver 200 additional copies for this purpose to the Subcommittee on Health office, room 1136 Longworth House Office Building, at least one hour before the hearing begins.
FORMATTING REQUIREMENTS:
Each statement presented for printing to the Committee by a witness, any written statement or exhibit submitted for the printed record or any written comments in response to a request for written comments must conform to the guidelines listed below. Any statement or exhibit not in compliance with these guidelines will not be printed, but will be maintained in the Committee files for review and use by the Committee.
1. All statements and any accompanying exhibits for printing must be typed in single space on legal-size paper and may not exceed a total of 10 pages including attachments. At the same time written statements are submitted to the Committee, witnesses are now requested to submit their statements on an IBM compatible 3.5-inch diskette in ASCII DOS Text or WordPerfect 5.1 format. Witnesses are advised that the Committee will rely on electronic submissions for printing the official hearing record.
2. Copies of whole documents submitted as exhibit material will not be accepted for printing. Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material not meeting these specifications will be maintained in the Committee files for review and use by the Committee.
3. A witness appearing at a public hearing, or submitting a statement for the record of a public hearing, or submitting written comments in response to a published request for comments by the Committee, must include on his statement or submission a list of all clients, persons, or organizations on whose behalf the witness appears.
4. A supplemental sheet must accompany each statement listing the name, full address, a telephone number where the witness or the designated representative may be reached and a topical outline or summary of the comments and recommendations in the full statement. This supplemental sheet will not be included in the printed record.
The above restrictions and limitations apply only to material being submitted for printing. Statements and exhibits or supplementary material submitted solely for distribution to the Members, the press and the public during the course of a public hearing may be submitted in other forms.
The
Committee seeks to make its facilities accessible to persons with
disabilities. If you are in need of special accommodations, please
call 202-225-1721 or 202-226-3411 TTD/TTY in advance of the event
(four business days notice is requested). Questions with regard to
special accommodation needs in general (including availability of
Committee materials in alternative formats) may be directed to the
Committee as noted above.