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Committees from both chambers approve HMO regulation package

JEFFERSON CITY - Legislation to give Missourians stronger rights in dealing with their health coverage plans cleared the first hurdles of the legislative process Thursday.

Both House and Senate committees approved, with few changes, a sweeping package of HMO regulations proposed by a joint legislative committee on managed care.

After it passed 16-6 in the House committee and received unanimous consent in the Senate committee, House sponsor Tim Harlan said he was optimistic about the measure's chance of reaching the governor's desk.

"The combination of big business and insurance is difficult for consumers to ever defeat," said Harlan, D-Columbia. "I think we have true bi-partisan support."

The bills encompass a variety of regulations that would uniformly affect managed care providers statewide. The changes include a different grievance process, more information disclosure to consumers and a broader definition of the "emergency" care expenses providers would have to cover. The legislation also specifies that some specialists may be accessed without a referral from a primary care physician.

Amendments to both chambers' bills changed the lists of those medical providers. The House committee added dermatologists to the list and the Senate committee deleted chiropractors. Both chambers include dentists and eye doctors.

"I think if we add dermatologists, we're opening the floodgates for everyone else," said Rep. John Griesheimer, R-Huggins, referring to the abundance of medical specialists who want to be exempted from the referral process.

Rodney Gray, lobbyist for the Missouri Dermatological Society, said the addition is important because it would ensure patients access to dermatologists. He said direct access would lower costs.

Griesheimer and Harlan, who both served on the joint committee that drafted the legislation, expressed concern about the bill becoming bogged down if too much is added to it.

"If we do this, we're going to kill this bill right off the bat," Griesheimer said.

Harlan said he has nothing against dermatologists being exempted from the referral process, but expressed concerns about the potential costs.

Supporters and opponents are in disagreement over what sort of overall financial impact the bills would have.

Opponents contend stronger HMO regulation would drive up medical costs and give consumers fewer insurance choices.

"We want to see a truly consumer-driven bill," said Dan Mehan, of the Missouri Chamber of Commerce. "This is driven by special interests in medical fields."

Mehan said he believes independent market pressures will guide the managed care industry to keeping costs down. He said this legislation gets away from what he sees as the true concept of managed care by imposing undue regulation.

"If you want to return to fee-for-service and double-digit increases, support this bill," Mehan said.

However, Harlan said there is no proof that this bill will raise costs. He referred to managed care companies who currently adhere to these standards, saying they haven't experienced cost increases.