[Congressional Record Volume 141, Number 143 (Thursday, September 14, 1995)]
[Extensions of Remarks]
[Page E1788]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


     MEDICARE PATIENTS DESERVE FULL CHOICE OF HEALTH CARE PROVIDER

                                 ______


                           HON. SHERROD BROWN

                                of ohio

                    in the house of representatives

                      Thursday, September 14, 1995
  Mr. BROWN of Ohio. Mr. Speaker, the Congress is about to embark on 
major reforms of the Medicare Program--ostensibly to ensure Medicare 
patients more choice. But I believe that the reforms we will be 
considering will offer patients less choice, not more, unless we take 
action to ensure that their choices are protected.
  Many of the so-called reform plans include efforts to increase the 
use of managed care for Medicare patients. I believe that these plans 
must include safeguards to protect Medicare patients' ability to choose 
the person who provides them health care services. For this reason, 
today I am introducing legislation to guarantee older Americans a 
point-of-service option under Medicare managed care plans.
  The Medicare Patient Choice Act provides true choice by allowing 
Medicare patients to go outside of a network when they need services. 
In addition, the bill would establish safeguards under managed care 
arrangements to ensure that patients are treated fairly and that they 
have recourse if they are dissatisfied with the care they receive. In 
addition, the bill prohibits the use of financial incentive plans which 
discourage providers to refer patients for specialty or other types of 
health care services.
  Further, this legislation ensures that patients get what they pay for 
under managed care arrangements by requiring plans to return to 
patients at least 85 percent of the aggregate premiums received in 
health care items, services, and treatment. Finally, the legislation 
would apply its requirements to the so-called Medicare Select plans.
  Mr. Speaker, I believe this legislation provides essential 
protections for Medicare patients and I hope that many of my colleagues 
who are concerned about the quality of health care provided to senior 
citizens will sign on as cosponsors. A summary of the legislation 
follows:
 Summary of the Medicare Patient Choice Act Introduced by Congressman 
                             Sherrod Brown

       The Medicare Patient Choice Act would:
       Require all Medicare managed care organizations (MCO) as a 
     condition of participating in Medicare to offer enrollees a 
     point-of-service option.
       Require MCOs to meet a loss-ratio (aggregate benefits to 
     premiums) of 85 percent.
       Require MCOs to issue an annual report to members providing 
     quality, access to services, enrollee's rights to benefits 
     and out-of-area coverage.
       Assure beneficiaries timely access to services, continuity 
     of care and the option to receive care out-of-the network.
       Establish grievance and appeals processes for both patients 
     and providers if they have a dispute with the MCO.
       Prohibit MCOs from discriminating against certain providers 
     based solely on their license or certification as provided 
     under state law.
       Ensure that Medicare network health plans include a 
     sufficient number, mix and distribution of health 
     professionals to meet the needs of their enrolled patients.
       Apply conditions of the Medicare Patient Choice Act to all 
     Medicare Select plans.
       Apply all requirements of physician incentive plans under 
     current law to all providers participating in Medicare 
     managed care plans.
     

                          ____________________