196 Pages of the Patient’s Bill of Rights

by Clive Riddle, June 24, 2010

This week, HHS, Department of Labor, and Department of The Treasury issued regulations to implement the Patient’s Bill of Rights referenced under the Patient Protection and Affordable Care Act.  A Fact Sheet summarizing these regulations was posted on healthreform.gov.   The 196 page Interim Final Rules have already been posted and the Federal Register will post the Rules on Monday (June 28^th.

President Obama remarked on the status of the Act, and the new Bill of Rights, in a White House Event, noting “The Departments of Health and Human Services, Labor and Treasury are issuing new regulations under the Affordable Care Act that will put an end to some of the worst practices in the insurance industry, and put in place the strongest consumer protections in our history -- finally, what amounts to a true Patient’s Bill of Rights. This long-overdue step has one overriding focus, and that’s looking out for the American consumer.  It’s not punitive.  As I said when I met with the insurance executives, it’s not meant to punish insurance companies.  They provide a critical service.  They employ large numbers of Americans.   And in fact, once this reform is fully implemented a few years from now, America’s private insurance companies have the opportunity to prosper from the opportunity to compete for tens of millions of new customers.  We want them to take advantage of that competition.”

As implementing regulations from the Act, there is no new policy here, just the creation of the document set forth in the Act with operational details. So in reading a summary of the Bill of Rights, you will certainly get déjà’ vu because all this was well covered in highlights of provisions of the Act itself.  Of course, the fun will be pouring through the 196 pages of details.

Never the less, here is a summary of what the detailed regulations address: Effective on or after September 23: insurance companies are barred from:

1. Imposing pre-existing condition exclusions on children
2. Rescinding or taking away coverage based on an unintentional mistake on an application
3. Setting lifetime limits on coverage
4. Restricting use of annual limits on coverage.
5. Restricting choice of the primary care doctor or pediatrician within a plan’s provider network
6. Requiring a referral for women to can see an OB-GYN
7. Requiring prior approval before seeking emergency care at a hospital outside the plan’s network.

(Items 5-7 apply to plans that are not grandfathered as defined in the regulations)