MDN.ORG:
Missouri Digital News
MDN.ORG
Mo. Digital News
Missouri Digital News
MDN.ORG:
Mo. Digital News
MDN.ORG:
Missouri Digital News
MDN.ORG:
Missouri Digital News
MDN.ORG
Mo. Digital News
Missouri Digital News
MDN.ORG:
Mo. Digital News
MDN.ORG:
Missouri Digital News
JEFFERSON CITY - Three weeks ago, Governor Mel Carnahan told the press that he did not feel managed health care needed regulating. But, at a House hearing Monday night, his staff asserted that his mind is changing.
"We generally support this bill," Mike Hartmann, the governor's deputy chief of staff, told the House Critical Issues Committee. "We're not prepared at this point to testify on the details."
Hartmann refused to give further comment on Carnahan's position.
He was one of a slew of witnesses to testify before the committee regarding managed care regulation, an issue that has become one of this session's most prominent topics.
House and Senate bills were drafted by a joint committee that met during the legislative intersession to research the need for managed care regulation in Missouri.
If the bill passes, managed care companies would be held to statewide standards for providing care.
Rep. Pat Kelly, R-Lee's Summit, questioned bill sponsor Tim Harlan, D-Columbia, on the need for regulation.
"Why is it our business to require HMOs to do any one of many certain things?" Kelly asked.
Harlan responded by saying many such industries are subject to government regulation and, in the interest of consumers, managed care needs government controls.
"The people that get hurt by this do not have the economic ability to make that change," Harlan said.
Dr. Jerry Kennett, a Columbia cardiologist, told committee members about a 37-year-old northern Missouri woman he feels was hurt by the existing managed care system.
The woman had chest pain, but she did not go to the hospital because she was unsure of whether her health maintenance organization would cover emergency room costs. The result was permanent heart damage; the woman now has only 60 percent use of her heart, Kennett said.
Harlan said the bill's definition of "emergency" is one of the most important aspects.
"Some companies define emergencies based on the final diagnosis," Harlan said.
Under the bill, emergencies would be determined under a "prudent layperson" definition. That means a patient with symptoms that an average person would consider severe would warrant insurance coverage for emergency treatment.
Many managed care companies already use this definition, and it works well, Harlan said.
"This does not mean that people can go to the emergency room at any time for any thing and the company will have to pay for it," he said, citing that a common cold would not warrant emergency attention.
Other witnesses spoke of difficulties getting HMOs to cover medical expenses. Some said they feel there is a need for making a policy's stipulations more clear to the patients, something that would be required under the bill.
"Many of my patients sign up for managed care with little knowledge except that it's the plan with the lowest premium," said Dr. Ed Ailor, a Columbia ear, nose and throat specialist.
The Senate Aging, Families and Mental Health Committee will hear the Senate managed care regulation bill at 2:00 today in the Senate Lounge.