Overview: On March 26, 1997, President Clinton created the Advisory Commission on Consumer Protection and Quality in the Health Care Industry and charged it with recommend[ing] such measures as may be necessary to promote and assure health care quality and value and protect consumers and workers in the health care system." As part of that charge, the President asked the Commission to develop a "Patients' Bill of Rights" in health care.
In February 1998, President Clinton directed the Department of Health and Human Services (HHS), along with the departments of Labor, Defense, and Veterans' Affairs and the Office of Personnel Management, to use their regulatory and administrative authority to bring their health programs into compliance with the Bill of Rights and Responsibilities.
HHS' Health Care Financing Administration (HCFA) has begun the work to establish new requirements for managed care plans participating in the Medicare program. It is also working to strengthen protections for beneficiaries enrolled in Medicaid managed care. In November 1998, HHS issued a report to the Vice President showing that it is moving aggressively to strengthen existing patient protections under Medicare and Medicaid.
When these regulations are fully implemented, Medicare and Medicaid will have among the strongest patients' protections in the country. The proposed regulations give HHS a variety of monitoring and enforcement tools, including suspension of payments, civil monetary penalties, and termination from the Medicare and Medicaid programs.
BACKGROUND: THE PRESIDENT'S ADVISORY COMMISSION ON CONSUMER PROTECTION AND QUALITY IN THE HEALTH CARE INDUSTRY AND THE PATIENTS' BILL OF RIGHTS
In November 1997, President Clinton's Advisory Commission on Consumer Protection and Quality on the Health Care Industry, in an Interim Report, issued the Patients' Bill of Rights and Responsibilities. The Commission's Final Report, "Quality First: Better Health Care for All Americans," was issued in March 1998.
Co-Chaired by Secretary of Health and Human Services Donna E. Shalala and Secretary of Labor Alexis M. Herman, the Commission had 34 members, including broad-based representation from consumers, businesses, labor, health care providers, health plans, and health care quality and financing experts.
The Patients' Bill of Rights and Responsibilities has three goals: to strengthen consumer confidence that the health care system is fair and responsive to consumer needs; to reaffirm the importance of a strong relationship between patients and their health care providers; and to reaffirm the critical role consumers play in safeguarding their own health. The Commission articulated seven sets of rights and one set of responsibilities:
· The Right to Information. Patients have the right to receive accurate, easily understood information to assist them in making informed decisions about their health plans, facilities and professionals.
· The Right to Choose. Patients have the right to a choice of health care providers that is sufficient to assure access to appropriate high-quality health care including giving women access to qualified specialists such as obstetrician-gynecologists and giving patients with serious medical conditions and chronic illnesses access to specialists.
· Access to Emergency Services. Patients have the right to access emergency health services when and where the need arises. Health plans should provide payment when a patient presents himself/herself to any emergency department with acute symptoms of sufficient severity "including severe pain" that a "prudent layperson" could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
· Being a Full Partner in Health C