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HMO Regulation Passes

May 14, 1997
By: Ann S. Kim
State Capital Bureau

JEFFERSON CITY - House members gave a rare round of applause Wednesday (May 14) night to the House sponsor of managed care legislation after he got final approval to send his managed care bill to the governor.

Rep. Tim Harlan, D-Columbia, said the bill, which received broad bipartisan support and passed with a wide margin, was "very easily could be the most significant bill that passes this session."

Congratulations went around for Harlan and other members of the joint committee who had worked on the bill since last fall.

"I did not envision this kind of support," Harlan said.

Harlan credited the bill's success to the bipartisan committee, saying that those ten people worked well and supported the legislation throughout the entire process.

The measure would require HMOs to clarify the care provided for by their plans. Other regulations addressed the concerns of consumers voiced during several months of public hearings.

Missouri consumers would not longer be "left to the mercy of HMOs," Harlan said.

Doctors in HMOs could no longer be subject to "gag clauses" which keep them from telling patients about all their medical options.

A "prudent layperson's" standard would be adopted for emergency room services. The most cited example of the need for this provision was patients who went to the emergency room with chest pains mistakenly thinking they were having a heart attack. Under this legislation, HMOs would have to pay for these patients' emergency room care.

The bill also establishes grievance procedures for complaints against HMOs, the most important provision for Missouri consumers, according to Harlan.

"There's now a very clear appeals process," Harlan said. An independent panel would make the final decision about complaints.

Opposition to the bill came from the business community. A compromise was reached by exempting business with fifty or fewer employees from some of the bill's provisions.

"It's a great day for Missouri residents and health care," said a grinning Sen. Joe Maxwell, D-Mexico, Senate sponsor of the bill.