ANNAPOLIS A bill endorsed by Gov. Parris N. Glendening to expand rights for managed care patients is almost assured to become law now that it unanimously passed the Senate and received an overwhelming endorsement in the House.
The Patients’ Bill of Rights, which won a 47-0 vote in the Senate Friday, would allow patients with a life- threatening disease or a chronic or disabling condition to visit their specialist multiple times without having to get new referrals from their primary care physician. It also would require health maintenance organizations to cover prescription medication not on their approved list if medically necessary or if no equivalent prescription drug is listed.
The Patients’ Bill of Rights was passed by the House earlier this week, 129-3, but without a provision mandating a 48-hour minimum hospital stay for patients who undergo mastectomies and testicle removal.
The Senate bill also deviates from the House bill in that it would require managed care companies to include policy issues in their enrollment sales materials, such as whether the company would substitute or exclude certain drugs prescribed by a physician or how often the plan changes its drug formulary.
A conference committee will resolve differences between the bills.
Glendening Friday urged the committee to leave the 48- hour protection provision in the legislation. The decision to stay for two days should be left up to the woman and her physician, he said, not an HMO.
“A woman who has experienced a mastectomy should not be pushed out the door before she’s ready simply to help reduce the hospital’s length-of-stay statistics. That is just wrong,” the governor said in a prepared statement. “We allow new mothers a 48-hour hospital stay, and we should do the same for a woman who undergoes a mastectomy.”
But D. Robert Enten, a lobbyist for the Maryland Association of Health Maintenance Organizations, said the industry doesn’t believe lawmakers should mandate length-of- stay issues.
“Clearly, during hearings we’ve had on this issue there was no testimony that managed care companies limit length of stay for mastectomies,” he said. A decision on length of stay, he added, is “better left out of the legislative process and left up to the patient and the physician.”
Under special circumstances, such as if the mastectomy or testicle removal is performed on an out-patient basis, managed care companies would cover one home visit scheduled within 24-hours after discharge or two visits if the physician feels there is a need.
HMOs, managed care companies and business officials also have argued that the addition of mandates to health care will drive up costs.
Both bills would designate the Maryland Insurance Administration as a central consumer information center for health-related issues and require insurers to provide out- of-network referrals to a specialist when a primary care physician in not available.
Though he co-sponsored the Patients’ Bill of Rights and believes it will bring Maryland national attention, Sen. Leo Green, D-Prince George’s, told the Senate Friday that all they were doing was “tinkering” with Maryland’s health care system.
“I think we are fooling ourselves if we believe this consumer protection bill addresses the bigger problem,” he said. “We are in a crisis. We have to find some way as a state or a nation to address ways to have affordable health care for everyone and…apply some accountability to managed care organizations.”
Senate President Thomas V. Mike Miller Jr., D-Prince George’s, agreed but warned that doing too much at once can be detrimental to progress.
“When you try to do everything at one time, it’s like a house of cards it falls over,” he said. “What we are doing is building up the health care system incrementally and moving ahead with it so that, hopefully, some day in the future we can have universal coverage.”