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U.S. Labor Secretary Alexis M. Herman today announced three initiatives
to implement President Clinton's Consumer Bill of Rights and Responsibilities
directive to improve the quality and fairness of health care for millions of
Americans.
Last November, the President directed the Departments of Labor, Health
and Human Services, Defense, Veterans Affairs, and the Office of Personnel
Management to assess ways to implement the bill of rights--prepared by the
President's Advisory Commission on Consumer Protection and Quality in the
Health Care Industry--and then report back to him in February. Today, the
President issued an executive order directing the departments to implement
initiatives identified in the reports in order to come into compliance with the
Consumer Bill of Rights.
"The Labor Department is deeply committed to the President's and
Commission's goals of quality, fairness and responsibility in the selection and
provision of health care services," Herman said. "As the Labor Department's
analysis of the Bill of Rights indicated, federal legislation is necessary to
ensure consumer rights. I look forward to working closely with the Congress to
develop bipartisan legislative proposals to ensure that those rights are
legally enforceable." Secretary Herman serves as co-chair of the Commission.
Herman announced that the department will undertake three major
initiatives to advance the Consumer's Bill of Rights by:
- issuing new claims procedures to protect plan participants;
- expanding information and disclosure to plan participants; and
- offering guidance to clarify that plan fiduciaries must take quality
into account when selecting service providers.
The Labor Department oversees approximately 2.5 million health plans
sponsored by private sector companies and unions. These plans cover
approximately 125 million workers, retirees and their families. The
department's Pension and Welfare Benefits Administration (PWBA) is responsible
for administering and enforcing Title I of the Employee Retirement Income
Security Act (ERISA) which governs these plans.
The department will propose amendments to ERISA's regulations governing
plans' internal claims procedures. This proposal will strengthen plans'
internal appeals processes to ensure participants receive a fair and efficient
benefits review. The proposal will also require that decisions regarding urgent
care claims be resolved within not more than 72 hours, and that decisions
regarding non-urgent care generally be resolved within 15 days. The proposed
amendments also will require consultation with qualified medical professionals
in deciding appeals involving medical judgments.
The department will propose amendments to ERISA's disclosure regulations
to provide participants of group health plans with clear and understandable
information. The proposed amendments will require plans to include such
information in their summary descriptions consistent with the Commission's
recommendations, including coverage of out-of-network services, conditions for
access to speciality medical care, preauthorization and utilization review
procedures.
In addition, the department recently issued guidance to plan fiduciaries
clarifying that they have a duty to take quality into account when selecting
health care service providers. When assessing the quality of services,
fiduciaries may consider such issues as the scope of choices and qualifications
of medical providers and enrollee satisfaction statistics.
Meanwhile, the Labor Department has implemented new procedures to
expedite assistance to participants and beneficiaries seeking help with denied
claims or services related to necessary emergency or medical care through its
consumer assistance program. Each of the department's 15 field offices and
national office in Washington, have trained personnel to assist with
participant inquiries and requests for assistance. The general number in
Washington for such assistance is (202) 219-8776.
Although ERISA currently protects health and pension benefits that
employers voluntarily provide for their workers, the law focuses primarily on
pension abuses and does not provide extensive standards for health plans.
"Consequently," noted Assistant Secretary for PWBA Olena Berg, "DOL has been
limited by the statute in its ability to ensure that ERISA-covered health plans
have sufficient consumer protections."
ERISA and its regulations ensure that consumers in ERISA plans are
provided with plan descriptions, an internal claims procedure to review and
appeal consumer grievances regarding benefits and generally grants participants
access to the plan document under which plans are operated. ERISA also
prohibits plans from discriminating against consumers on the basis of health
status.
Archived News Release Caution: Information may be out of date.
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