    [Public Papers of the Presidents of the United States: William J. Clinton (1998, Book I)]
    [February 20, 1998]
    [Pages 260-261]
    [From the U.S. Government Publishing Office www.gpo.gov]

    [[Page 260]]

    Memorandum on Federal Agency Compliance With the Patient Bill of Rights
    February 20, 1998

    Memorandum for the Secretary of Defense, the Secretary of Labor, the
    Secretary of Health and Human Services, the Secretary of Veterans
    Affairs, the Director of the Office of Personnel Management

    Subject: Federal Agency Compliance with the Patient Bill of Rights

        Last November, I directed you to review the health care programs you
    administer and/or oversee and report to me on the level and adequacy of
    the patient protections they provide. Specifically, I asked you to
    advise me on the extent to which those programs are in compliance with
    the Health Care Consumer Bill of Rights (the ``Patient Bill of Rights'')
    recommended by the Advisory Commission on Consumer Protection and
    Quality in the Health Care Industry (``the Quality Commission'').
        Yesterday, you formally conveyed your reports to me through Vice
    President Gore. He advises me that each of your agencies is well on its
    way toward full compliance with the patient protections recommended by
    the Quality Commission. By doing so, your agencies will serve as strong
    models for health plans in the private sector.
        Under your leadership, we are showing that it is possible and
    desirable to ensure that patients have the tools they need to navigate
    through an increasingly complex health care delivery system. We are
    showing that common sense solutions for all too common problems in our
    health systems are the right prescription not only for beneficiaries of
    Federally administered programs, but for our private sector colleagues
    as well. Your efforts illustrate that patient protections can be
    accomplished without excessive costs or regulations.
        While the news is encouraging, your reports also indicate that we
    have not completed the job. Although Federal health programs are taking
    a leading role in providing protections to patients, your report
    indicates we have the regulatory and administrative authority to come
    into substantial compliance with the Patient Bill of Rights, and I
    believe that this should be one of my Administration's highest
    priorities.
        Therefore, I hereby direct you to take the following actions
    consistent with the missions of your agencies to come into compliance
    with the Patient Bill of Rights.
        The Secretary of Health and Human Services shall:
         take all appropriate administrative actions to ensure that
                the Medicare and Medicaid programs come into substantial
                compliance with the Patient Bill of Rights, including access
                to specialists and improved participation in treatment
                decisions, by no later than December 1999; and
         notify all State Medicaid directors that emergency room
                care protections should be consistent with the Patient Bill
                of Rights.
        The Director of the Office of Personnel Management shall:
         ensure that all 350 Federal Employees Health Benefits Plan
                (FEHBP) participating carriers come into contractual
                compliance with the Patient Bill of Rights, particularly
                with regard to access to specialists, continuity of care,
                and access to emergency room services by no later than
                December 31, 1999; and
         with respect to participating carriers, propose regulations
                to prohibit, within 90 days, practices that restrict
                physician-patient communications about medically necessary
                treatment options.
        The Secretary of Veterans Affairs shall:
        take the necessary administrative action to ensure that a
                sufficient appeals process is in place throughout the
                Veteran's Health System by September 30, 1998; and
        issue a policy directive to ensure that beneficiaries in the
                Veteran's Health System are provided information consistent
                with the Patient Bill of Rights by September 30, 1998.
        The Secretary of Defense shall:
        establish a strong grievance and appeals process consistent
                with the Patient Bill of Rights throughout the military
                health system by September 30, 1998;

    [[Page 261]]

        issue a policy directive to promote greater use, within the
                military health system, of providers who have specialized
                training in women's health issues to serve as primary care
                managers for female beneficiaries and to ensure access to
                specialists for beneficiaries with chronic medical
                conditions by September 30, 1998; and
        issue a policy directive to ensure that all patients in the
                military health system can fully discuss all treatment
                options. This includes requiring disclosure of financial
                incentives to physicians and prohibiting ``gag clauses'' by
                September 30, 1998.
        The Secretary of Labor shall:
        propose regulations to strengthen the internal appeals
                process for all Employee Retirement Income Security Act
                (ERISA) health plans to ensure that decisions regarding
                urgent care are resolved within 72 hours and generally
                resolved within 15 days for non-urgent care; and
        propose regulations that require ERISA health plans to
                ensure the information they provide to plan participants is
                consistent with the Patient Bill of Rights.

                                                          William J. Clinton