[Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (2000-2001, Book III)]
[November 4, 2000]
[Page 2458]
[From the U.S. Government Publishing Office www.gpo.gov]



[[Page 2458]]


Memorandum on Providing Patient Protections Through Final Regulations on 
Internal Appeals and Information Disclosure
November 4, 2000

Memorandum for the Secretary of Labor

Subject: Providing Patient Protections Through Final Regulations on 
Internal Appeals and Information Disclosure

    In 1997, I appointed you and Secretary of Health and Human Services, 
Donna E. Shalala, to co-chair the Advisory 
Commission on Consumer Protection and Quality in the Health Care 
Industry (the ``Quality Commission''). Through the extraordinary efforts 
of you and Secretary Shalala in bringing together a broad and diverse 
group of commission members, the Quality Commission identified numerous 
shortcomings related to consumer protections in the Nation's frequently 
evolving health-care delivery system.
    Among numerous problems within the health-care delivery system, the 
Quality Commission specifically cited that tens of millions of Americans 
with private health insurance do not have access to a fair and timely 
appeals process. More specifically, under the Employee Retirement Income 
Security Act (ERISA), 130 million Americans with employer-sponsored 
health plans lack the protection of a meaningful internal appeals 
process when plans deny benefits for health care. Health plans making 
benefit decisions often do not have the medical expertise to make such 
decisions and appeals of these decisions can take as long as 300 days. 
As a consequence, countless Americans have been harmed by inappropriate 
delays and denials of benefits.
    The Quality Commission recommended that the benefit appeals and 
information shortcomings, which hurt American patients and their 
families, be addressed through a Consumer Bill of Rights. Such 
improvements were an important element of a broader array of patient 
protections including a right to see a specialist, a right to receive 
emergency care, and a right to continue ongoing medical treatment 
without disruption. Since the release of the Quality Commission's 
findings, my Administration has been working with a bipartisan group of 
Members of Congress who are committed to enacting these and other 
critical protections, such as holding health plans accountable when they 
take actions that injure patients.
    As we have worked to pass a bipartisan, enforceable Patients Bill of 
Rights, you have held public hearings that confirmed the need for a wide 
range of protections, with a particular focus on those protections my 
Administration can extend by executive action: a fair and timely process 
for internal appeals and meaningful information disclosure to consumers. 
With my concurrence, you have not implemented these protections because 
of our mutual belief that it would be far better to establish them in 
the context of broader protections that would be included should the 
Patients Bill of Rights be passed by the Congress. Unfortunately, it now 
appears clear that this Congress will not pass a meaningful and 
enforceable Patients Bill of Rights this session. With this in mind, I 
hereby direct as follows:
    You shall in the next 2 weeks promulgate final regulations 
protecting millions of individuals with employer-based health coverage. 
The regulations shall establish a fair and unbiased process for 
reviewing medical benefits claims, require timely coverage and appeal 
decisions, and direct plans to provide meaningful information to 
patients advising them of their rights to the appeals process.
    This memorandum is not intended to create any right or benefit, 
substantive or procedural, enforceable at law or equity by a party 
against the United States, its agencies, or instrumentalities, or any 
other person.

                                                      William J. Clinton