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 this was sent to me from my sister. I know nothing of  managed care,
except what is sent out by the
Texas Insurance Board and that which is on TV. Don't belong to a managed
care system, but you may find this interesting.

> The Arc Governmental Affairs
> http://TheArc.org/ga/Governmental_Affairs.html
>
> ACTION ALERT
>
> September 28, 1999
>
> Governmental Affairs Office,
> 1730 K Street,
> N.W., Suite 1212, Washington, D.C. 20006
> (202) 785-3388 / FAX (202) 467-4179 /
> TDD (202) 785-3411 / E-Mail [log in to unmask]
>
> Action Needed to Ensure a Clean and Fair Vote on the
> Norwood-Dingell Bipartisan Managed Care Bill
>
> Background: Speaker of the House Dennis Hastert (R-IL)
> has promised to allow a floor vote on managed care
> legislation the week of Oct. 4.  Currently, the Speaker has
> promised a vote on H.R. 2723, the Bipartisan Consensus
> Managed Care Act of 1999 (Norwood-Dingell) and
> H.R. 2824, the Health Care Quality and Choice Act of 1999
> (Coburn-Shadegg).  However, since neither of these bills
> have the support of the House Republican leadership, it is
> probable that a third bill will also be voted on.
>
> It is most likely that bill will be H.R. 2926, the Comprehensive
> Access and Responsibility in Health Care Act (Boehner)
> which has the support of the leadership.
>
> The Arc and other health care advocates support H.R. 2723,
> the Bipartisan Norwood-Dingell bill.  It is the bill that would
> do the most for children and adults with mental retardation
> and their families.
>
> There are two possible scenarios and both place H.R. 2723
> in jeopardy:
>
> (1) there could be a King of the Hill vote where  the last bill
> that passes is the one that wins. This means our message
> to House members is vote FOR H.R. 2723 and against the
> others.
>
> (2) There could be a rule passed that attaches "poison pills"
> like MEWAs and Medical Savings Accounts to whatever bill
> passes. This means our message to House members is
> pass a clean bill.
>
> H.R. 2723 is a strong bill that should be enacted into law.
> It currently has 22 Republican sponsors. These Republicans
> really need your support.  They are taking a stand in opposition
> to their leadership because they know that consumer's need
> protection (see attached list).
>
> Action:
>
> 1. Contact your Representative this week.  Urge him/her
> to vote for H.R. 2723 and against any other proposal that
> comes up.
>
> 2. Ask your Representatives to tell Speaker Hastert that
> they want a clean bill with no "poison pills".
>
> 3. Ask your Representatives to vote against any poison pills.
>
> Staff Contact:  Kathy McGinley, 202/785-3388; [log in to unmask] -
> attached summary of H.R. 2723 and list of co-sponsors.
>
> ___________
>
> Summary of H.R. 2723
> The Bipartisan Consensus Managed Care Act of 1999
>
> This bill - while not S.6/H.R. 358 - the Patients' Bill of Rights -
> is a strong bill that should be enacted into law.   It is also,
> most likely, the best managed care reform bill with any chance
> of passage this year.  H.R. 2723 includes a number of
> provisions important to children and adults with disabilities
> and their families.
>
> * Access to specialty care, including the opportunity to
> have a specialist as the gatekeeper or a standing referral
> for individuals with "ongoing special conditions". Ongoing
> special condition is defined as a "condition or disease
> that is life-threatening, degenerative, or disabling and
> requires specialized medical care over time".
>
> * Continuity of care protections so that individuals with
> ongoing special conditions can continue to see their provider
> for a set period of time if, for some reason, the provider is no
> longer part of the plan.
>
> * Access to prescription drugs not in a plan's formulary if it
> is shown that a drug, other than those offered by the plan, is
> medically indicated.
>
> * Access to an independent external appeals process that
> leaves decision making up to health care professionals and
> not insurance companies.
>
> * Access to fair remedies if a health plan decision causes harm.
>
> * The bill does not include a definition of medical necessity.
> Instead it leaves the final decision on medical necessity to the
> physicians who conduct the independent external review.  Their
> decisions would be legally binding on the health plan. Claims
> that can be taken to the external appeals process are those
> "based in whole or part on a decision that the item or service
> is not medically necessary or appropriate or is investigational
> or experimental or in which the decision as to whether a
> benefit is covered involves a medical judgement".  The bill
> specifically states that the external reviewers will consider -
> but not be bound by - a plan's definition of medical necessity.
>
> * The bill would remove the ERISA preemption and allow
> consumers to hold health plans accountable according to state
> law.  Plans that comply with an external reviewer's decision may
> not be held liable for punitive damages.   However, if a health
> plan does not comply with the external reviewers'
> recommendations, a consumer could then take a plan to federal
> court to enforce the decision.
>
> * For up-to-date information on co-sponsors, etc. see.
> www.house.gov/commerce_democrats
>
> * For specific CCD Health Task Force positions see the
> Health Task Force web page: www.c-c-d.org/tf-health.htm
>
>
>
> H.R.2723 SPONSOR:  Norwood, Charlie
> 65 co-sponsors:
> ARKANSAS
> Berry, Marion  (D-AR)
> Snyder, Vic (D-AR)
>
> CALIFORNIA
> Capps, Lois (D-CA)
> Horn, Stephen (R-CA)
> Stark, Fortney Pete (D-CA)
> Waxman, Henry A. (D-CA)
> Eshoo, Anna G. (D-CA)
>
> CONNECTICUT
> Shays, Christopher (R-CT)
>
> FLORIDA
> Shaw, E. Clay, Jr. (R-FL)
> Foley, Mark (R-FL)
> Thurman, Karen L. (D-FL)
>
> GEORGIA
> Barr, Bob (R-GA)
>
> ILLINOIS
> Schakowsky, Janice D. (D-IL)
> Rush, Bobby L. (D-IL)
> Phelps, David D. (D-IL)
>
> IOWA
> Ganske, Greg (R-IA)
> Leach, James A. (R-IA)
>
> LOUSIANA
> Cooksey, John (R-LA)
> John, Christopher (D-LA)
>
> MAINE
> Baldacci, John Elias (D-ME)
>
> MARYLAND
> Gilchrest, Wayne T. (R-MD)
> Cardin, Benjamin L. (D-MD)
> Morella, Constance A. (R-MD)
> Wynn, Albert Russell (D-MD)
>
> MICHIGAN
> Dingell, John D. (D-MI)
> Kilpatrick, Carolyn C. (D-MI)
> Stabenow, Debbie (D-MI)
> Bonior, David E. (D-MI)
>
> MISSOURI
> Gephardt, Richard A. (D-MO)
> Clay, William (Bill) (D-MO)
> NEVADA
> Gibbons, Jim (R-NV)
> Berkley, Shelley (D-NV)
>
> NEW JERSEY
> Pallone, Frank, Jr. (D-NJ)
> Roukema, Marge (R-NJ)
> Frelinghuysen, Rodney P. (R-NJ)
> Andrews, Robert E. (D-NJ)
> LoBiondo, Frank A. (R-NJ)
> Pascrell, Bill, Jr. (D-NJ)
> Holt, Rush D. (D-NJ)
>
> NEW YORK
> Rangel, Charles B. (D-NY)
> Houghton, Amo (R-NY)
> Gilman, Benjamin A. (R-NY)
> Boehlert, Sherwood L. (R-NY)
> McCarthy, Carolyn (D-NY)
> Forbes, Michael P. (R-NY)
>
> NORTH CAROLINA
> Clayton, Eva M. (D-NC)
>
> OHIO
> Brown, Sherrod (D-OH)
> LaTourette, Steve C. (R-OH)
>
> PENNSYLVANIA
> Klink, Ron (D-PA)
> Doyle, Michael F. (D-PA)
> Murtha, John P. (D-PA)
>
> RHODE ISLAND
> Weygand, Robert A. (D-RI)
>
> SOUTH CAROLINA
> Graham, Lindsey O. (R-SC)
>
> TENNESSEE
> Ford, Harold Jr. (D-TN)
> Tanner, John S. (D-TN)
>
> TEXAS
> Turner, Jim (D-TX)
> Sandlin, Max (D-TX)
> Brady, Robert (R-TX)
> Frost, Martin (D-TX)
> Hall, Ralph M. (D-TX)
>
> VIRGINIA
> Boucher, Rick (D-VA)
>
> WASHINGTON
> McDermott, Jim (D-WA)
> Dicks, Norman D. (D-WA)
>
> WISCONSIN
> Barrett, Thomas M. (D-WI)
>
> WYOMING
> Cubin, Barbara (R-WY)
>
>
> ______________________________________________________________________
>
>
>
>
>
>
>
>


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