Oregon AFL-CIO backs "patients' bill of rights" bill for 2001 Legislature

The Oregon AFL-CIO will join forces with the business group Associated Oregon Industries (AOI) and a health care purchasers coalition to move a "patients' bill of rights" through the 2001 Legislature.

The state labor federation's Executive Board unanimously approved a draft of the bill at its quarterly board meeting in Portland Dec. 1. It joins the Oregon Health Care Purchasers Coalition in ratifying the proposal that now awaits approval of AOI, whose board doesn't meet until January.

The consensus legislation is the result of a "Patient Protection Work Group" convened by Governor John Kitzhaber earlier this year. His charge was to develop legislation that addressed many of the issues raised by the AFL-CIO in a series of initiative petitions that it filed with the secretary of state earlier this year. The initiatives outlined certain rights that health care patients should have with their health care provider with regard to independent review, referral to specialists, continuity of care, and right to sue.

None of those initiatives ever made it to the ballot because the state labor federation stopped collecting signatures on them in view of the governor's proposal to bring the groups together to work out a compromise.

Tim Nesbitt, president of the Oregon AFL-CIO, was labor's representative on the work group, which included representatives from Regence BlueCross/ BlueShield, ODS Health Plan, PacifiCare of Oregon, Kaiser Permanente, Providence Health Plan, Oregon Health Action Campaign, Campaign for Patients' Rights, AOI, and the Public Employees Benefit Board.

The ground rules incorporated in the agreement prior to the first meeting stipulated that all parties would work in good faith to achieve legislative passage and "will not support other legislative proposals addressing any of the core issues" in the upcoming session of the Legislature.

Those ground rules, Nesbitt said, do not preclude organized labor from being active on other issues relating to health care, including prescription drug cost control, protection of the Oregon Health Plan, or the Safe Hospital Campaign, which has to do with staffing levels.

The proposal developed by the work group applies to all health plans regulated by the state. It will not apply to the Oregon Health Plan, Medicare or ERISA plans - including self-insured, employer trusts or Taft-Hartley plans.

The proposal now goes to the Legislature with no room for tweaking, Nesbitt said. "This is the deal for the 2001 session," he told the Executive Board.

To get the final proposal, all groups at the table had to agree to the language, otherwise it wasn't included. The proposed legislation includes the following major provisions:

Independent Review - Plans will be required to submit certain disputes for independent review at the request of a patient. The requirement applies to disputes about denials of service based on a plan decision that a service is experimental or is not medically necessary. The review would be conducted by independent review organizations (IRO) selected by the Department of Consumer and Business Services. If a plan promises by contract to be bound by IRO decisions, that promise is enforceable. If a plan does not promise to be bound by all IRO decisions, then if a plan fails to follow an IRO's decision a patient can sue for damages for all losses sustained as a result.

Right to Sue - A patient may sue a plan if it fails to abide by an IRO decision.

Continuity of Care - If a patient is undergoing an active course of treatment when his or her provider discontinues a contract with the patient's health plan, the patient may continue treatment with that provider for 120 days or until the course of treatment is completed, whichever comes first. The provider continues to be paid by the health care plan.

Referral to Specialists - Health care plans must have procedures for ongoing referral to specialists and must allow patients to get a second opinion if they are denied a referral to a specialist.

Network Adequacy - It is an unfair trade practice to materially misrepresent the availability of covered services through a network. DCBS will adopt administrative rules providing for uniform indicators for reporting on health maintenance organization and preferred provider organization networks after consulting with an advisory group.

The proposed legislation contains elements of several initiative petitions the Oregon AFL-CIO had filed with the secretary of state's office earlier this year.

"We feel some of the language in the proposals is better than our original initiatives," said Lynn-Marie Crider, education and research director of the Oregon AFL-CIO, who assisted Nesbitt on the work group. Other portions of the proposal weren't as good as labor would have liked, and a couple of issues (prescription drugs and staffing levels) weren't even brought to the table.

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