From kal0303@doh.wa.gov Wed Jul 29 11:46:46 1998 Received: from mxu2.u.washington.edu (mxu2.u.washington.edu [140.142.32.9]) by lists.u.washington.edu (8.8.4+UW97.07/8.8.4+UW97.05) with ESMTP id LAA71790 for ; Wed, 29 Jul 1998 11:46:46 -0700 Received: from smtp.doh.wa.gov (hub.doh.wa.gov [192.230.1.5]) by mxu2.u.washington.edu (8.8.4+UW97.07/8.8.4+UW98.06) with SMTP id LAA11947 for ; Wed, 29 Jul 1998 11:46:45 -0700 Received: from Connect2 Message Router by smtp.doh.wa.gov via Connect2-SMTP 4.00; Wed, 29 Jul 98 11:47:43 -0700 Message-ID: <45B15D4A014C3700@smtp.doh.wa.gov> In-Reply-To: Date: Wed, 29 Jul 98 11:46:09 -0700 From: "Lukens-Bull, Katryne A." Sender: "Lukens-Bull, Katryne A." To: ph-assess@u.washington.edu Subject: Diversity issues X-mailer: Connect2-SMTP 4.00 MHS to SMTP Gateway Here is some informaiton from another listserve I subscribe to (it only sends messages quarterly so it is pretty good if anyone wants to subscribe) The National Conference on QUALITY HEALTH CARE FOR CULTURALLY DIVERSE POPULATIONS: Provider and Community Collaboration in a Competitive Marketplace October 1-4, 1998 New York City, NY jointly presented by U.S. Department of Health and Human Services Office of Minority Health The New York Academy of Medicine Resources for Cross Cultural Health Care Early registration closes August 15. ------------------------------------------------------- These new Medicare rules may have an impact on medical interpreter and other cultural competence services. Sweeping New Rules Are Set Out to Protect People on Medicare By ROBERT PEAR Tuesday, June 23, 1998 Copyright 1998 The New York Times WASHINGTON -- The Clinton administration ordered sweeping protections for Medicare beneficiaries on Monday, requiring health plans to guarantee access to specialists, to keep medical records confidential and to provide interpreters when needed. The new rules, which add muscle to a 1997 law, are stricter than the standards governing commercial health insurance in many states. The rules go beyond the 1997 law in some ways, establishing additional protections for women, for people with serious illnesses and for patients who cannot read or speak English. The rules apply to all Medicare services, but include special provisions for managed care plans. The administration said the new rules herald "the most significant change in the Medicare program since its inception in 1965." Included in the new rules are provisions that would ban health plans from discouraging sick people from enrolling and discriminating against Medicare beneficiaries by limiting or denying coverage because of physical or mental illness, genetic information, disability or prior use of medical care. Scores of private health plans will soon try to enroll older Americans, and the government, which pays an average of more than $5,600 a year for each beneficiary, devised the rules as a way to make sure that the anticipated growth of private health plans occurs under careful regulation. What Medicare does is important to the health care system as a whole for at least two reasons. With more than 38 million beneficiaries, Medicare directly influences the medical market in a big way. Moreover, its standards provide a template for other buyers, as employers and private insurers often follow the government's lead. Under the rules, Medicare beneficiaries may, on request, obtain information about the financial condition of a private health plan and how its doctors are paid. The rules are to be published in the Federal Register on Friday and will take effect 30 days later. The Medicare rules, which run to more than 165,000 words, also contain these requirements: -- Women may demand "direct access to a women's health specialist" for "women's routine and preventive health care services," including Pap smears and breast and pelvic examinations. Specialists include gynecologists and nurse-midwives. -- Patients with complex or serious medical problems must be allowed to go directly to medical specialists in some circumstances, for example, if a cancer patient has a treatment plan that calls for 10 rounds of chemotherapy. -- Health plans must provide services "in a culturally competent manner" to all Medicare patients, "including those with limited English proficiency or reading skills, diverse cultural and ethnic backgrounds and physical or mental disabilities." Health plans must try to enroll disabled people, as well as older Americans. -- Health maintenance organizations must pay for the treatment of any condition that "a prudent lay person" would regard as an emergency. A Medicare beneficiary enrolled in an HMO or other private health plan may not be charged more than $50 for services in a hospital emergency room. While most Medicare plans now charge less, there was no government limit. -- Health plans must protect the confidentiality of medical records and may not sell their members' names and addresses for any purpose, even for scientific studies. Patients are entitled to see their own records. These rules provide more protection than prior federal standards, but do not go as far as privacy advocates want. -- Private health plans may not "solicit door-to-door for Medicare beneficiaries." If they recruit patients in high-income areas, they must make "comparable efforts" in low-income neighborhoods. They may not offer cash rebates. -- Patients who believe they are too sick to go home may challenge a hospital's decision to discharge them. The patients may remain in the hospital, at no cost to themselves, until their cases have been reviewed by an impartial arbiter. -- A health plan must assess the health of each new member within 90 days after the person is enrolled. The rules establish elaborate procedures for grievances and appeals. In general, a health plan must rule on a patient's request for services as quickly as the person's condition requires -- within 14 days in most cases, or 72 hours in urgent cases. If the patient appeals, the health plan must issue its decision within 30 days, or 72 hours in urgent cases. Patients can pursue their claims through several levels of review leading ultimately to a federal court. In addition, the rules say, some Medicare beneficiaries may be able to recover damages under state law for injuries caused by medical malpractice. Candace K. Schaller, a vice president of the American Association of Health Plans, which represents the managed-care industry, said the new consumer protection standards were "generally reasonable." But, she added, health plans may need more leeway on some issues, like the time limits for deciding appeals. The Clinton administration says it will use the new rules to improve the quality of care for Medicare beneficiaries. It will set "uniform national performance standards," stipulating how many patients should receive mammograms or flu shots, for example, and the government may refuse to renew its contract with any health plan that fails to meet these goals. Each health plan will have to show "significant improvement" -- tentatively defined as a 10 percent reduction in bad outcomes -- in areas specified by the government. Thus, if 40 percent of the members of a particular health plan did not get flu shots, the goal would be to reduce this number to 36 percent. The rules also contain new protections for doctors. HMO's and other health plans that take Medicare patients must consult with their doctors in developing medical policies, clinical guidelines and procedures for controlling the use of costly services. Such guidelines must be based on "reasonable medical evidence," not just a desire to save money. If a health plan cancels or refuses to sign a contract with a doctor, it must explain its reasons. The doctor can appeal the decision and demand a hearing. Under the rules, a health plan may expel a Medicare beneficiary if the person is "disruptive, unruly, abusive or uncooperative," or fails to pay premiums within 90 days after being pressed for the amounts due. <<<<<< Diversity Rx will be adding new content regularly, and we encourage our readers to let us know about their linguistically and culturally appropriate health programs and policies. We welcome contributions in many forms, including article and book reviews, calendar events, letters to the editor and other formats described in our editorial guidelines. For more information, contact Editor Julia Puebla Fortier at RCCHC@aol.com. Diversity Rx is a clearinghouse of information on the World Wide Web on how to meet the language and cultural needs of minorities, immigrants, refugees and other diverse populations seeking health care. Diversity Rx is sponsored by The National Conference of State Legislatures Resources for Cross Cultural Health Care The Henry J. Kaiser Family Foundation. ******************************************************************** The DiversityRx-L distribution list is a service of NCSLnet, the Electronic Information Network for State Legislatures. National Conference of State Legislatures. For information on NCSLnet services send an e-mail message to: NCSLnet-Info@ncsl.org (subject and message text will be ignored). ----- Processed with Listserv Beta 1 for Wildcat v4 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Katryne Lukens Bull, MPH, CHES Phone: (360) 664-9381 Washington State Department of Health Fax: (360) 586-7424 Office of Planning Pager: (360) 971-0586 1112 SE Quince St. E-mail: kal0303@doh.wa.gov PO Box 47890 Olympia, Wa 98504-7890 .