Managed Care:

State Approaches on Selected Patient Protections

T-HEHS-99-85: Published: Mar 11, 1999. Publicly Released: Mar 11, 1999.

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Pursuant to a congressional request, GAO discussed selected state patient protection provisions already in place and congressional proposals under consideration, focusing on state statutes that relate to seven types of patient protections: (1) coverage of emergency services; (2) access to obstetricians and gynecologists; (3) access to pediatricians; (4) access to other specialists; (5) continuity of care for enrollees whose providers leave the plan; (6) drug formularies; and (7) patient-provider communication.

GAO noted that: (1) many states have responded to managed care consumers' concerns about access to health care and information disclosure; (2) however, they often differ in their specific approaches, in scope and in form; (3) two states--California and Minnesota--have laws or regulations that address all seven types of protections GAO analyzed; (4) two other states--Colorado and Massachusetts--have laws that address three or fewer protections; (5) the patient protection most common among the 15 states addresses open patient-provider communication; (6) provisions addressing coverage of emergency health care and access to certain specialists were also prevalent among states; (7) in contrast, only four states had specific provisions to guarantee direct access to pediatricians; (8) although several states have continuity-of-care provisions, they can differ markedly in the criteria for coverage and time period allowed for transition; (9) about half of the states specify pregnancy as a condition subject to continuity-of-care coverage; (10) most of these states allow women in their second trimester of pregnancy to qualify for continuity-of-care protection if their physician leaves the plan; and (11) one state requires that women be in their third trimester to receive such coverage.

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