New federal Medicare consumer protection rules being announced this week may go further toward raising awareness about HMO patient rights than in changing the way Minnesota's Medicare HMOs do business, health care industry analysts said Tuesday.
That's because many of those regulations already exist in Minnesota as a result of state laws and voluntary programs by health plans.
It is not yet clear how the proposed rules will be enforced beginning next year because the precise language has not yet been published. State health plans said Tuesday that they are not sure how the rules will change the health care provided to the 130,000 Minnesotans covered by Medicare HMO plans. Details of the new rules will be released Friday, according to news reports published Tuesday.
The Minnesota Department of Health's Kent Peterson, a regulator who oversees HMOs, said many of the proposed regulations already are state law.
The new proposals, which echo many of the provisions of Clinton's patient bill of rights, would add protections for women patients, people with serious illnesses and patients who can't read or speak English. They apply to all Medicare services, but include rules that relate only to Medicare HMOs.
Minnesota HMOs already operate under rules stating that they must allow women to have direct access to an obstetrician or gynecologist and that they are required to pay for reasonable emergency care, both provisions in the proposed Medicare rule changes.
"There are some portions that appear to go beyond our law," Peterson said.
For instance, the federal rules would require HMOs to provide "culturally competent" professionals, give Medicare enrollees direct access to specialists in certain cases and require HMOs to rule on appeals within 14 days. Minnesota's current standard is 30 days.
Health plan officials said they already voluntarily comply with many of the proposed provisions.
"The regulations, so far as we have been able to determine, seem very straightforward and are a collection of very good ideas, virtually all of which we fully comply with," said Sarah Stoesz of Medica.
The Clinton administration can impose the new regulations without congressional approval, and many industry analysts see the move as part of its push to broaden consumer protections for all HMO enrollees.
"Medicare is a huge federal program that really in many ways sets standards for the entire medical industry," said Dr. Kent Wilson, president of the Minnesota Medical Association. "The regulations in a sense will have the effect of raising awareness of all specific areas of patient protection and access and availability. There will be very clear ripple effects through Minnesota."
Of the approximately 650,000 Minnesotans covered by Medicare, about 20 percent are enrolled in Medicare HMOs provided by HealthPartners, Medica Health Plans and Blue Cross and Blue Shield of Minnesota. UCare Minnesota also has begun marketing a new Medicare HMO.
"We really don't feel it will have a dramatic effect in Minnesota because we have made so many improvements in this state," said Kate Stahl, executive vice president for issues with the Minnesota Senior Federation.
If anything, the federal regulations might help consumers make more informed choices because the rules will fill the gaps in state law and they will standardize consumer protections that Minnesota HMOs currently provide, Stahl said.
"We are asked to make decisions on health care, and often we haven't got a clue what we are asked to choose between," she said.
She wondered whether some proposed regulations would drive up premiums, especially those that require HMOs to provide health assessments to new members and to report health improvement data to the federal government.
But HealthPartners' chief executive, George Halvorson, said he didn't see premiums going up as a result of the new regulations.