[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