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HMO sponsors pledge a compromise in conference committee

May 09, 1997
By: Angela Greiling
State Capital Bureau

JEFFERSON CITY - The House sponsor of the managed care reform bill said he will accept a compromise the Senate made with business opposition.

Rep. Tim Harlan, D-Columbia said he will give his full support to an amendment, offered by Senate sponsor Joe Maxwell, D-Mexico, that would ease requirements to which businesses must adhere.

The House version would require employers who offer managed care packages to include a "point-of-service" coverage option. That means employers must offer at least one plan that gives consumers the right to pay an additional premium so they can go directly to a medical specialist without being referred by a primary care physician.

Under the Senate bill, employers with 50 or fewer employees would be exempted from offering a point-of-service option.

The bill, which was passed by the Senate Wednesday and by the House in April, is set to be heard by a House and Senate conference committee this week.

Maxwell said he isn't going to rush the process to get the bill into a committee meeting.

"It's a very big bill," he said. "There are always people who want to make sure people aren't trying to slip something into a 107-page bill."

Managed care reform has been one of the 1997 session's biggest issues. The bill, which was drafted by a joint committee that met during the legislature's recess last fall, would give consumers across the state more power when dealing with managed care companies.

Major provisions of the bill:

*Require managed care providers to pay for emergency room visits for things a "prudent layperson" would consider an emergency. Consumers have testified they have had problems getting their providers to pay for problems like broken bones and chest pain that does not result in a heart attack.

*Provide for a grievance process for complaints regarding managed care companies.

*Eliminate "gag clauses," which restrict physicians from informing patients about expensive treatment options.

During three days of debate on the issue last week, the Senate added more than 20 amendments.

With the exception of two amendments he sponsored, including the point-of-service compromise, Maxwell said he isn't attached to any of them and is willing to be flexible in the conference committee.

"I'm one of those eternal optimists that believe everything can be worked out," Maxwell said.

Harlan said he does not disagree with any of the Senate additions.

"I don't think there are any that are terrible," he said of the amendments that must be worked out in the conference committee.

The managed care reform measure received considerable opposition from powerful business groups.

"It had a lot of steam with it, coming out of the Senate especially," Missouri Chamber of Commerce lobbyist Dan Mehan said of the bill in its initial stages.

Mehan said the Senate amendments, especially the point-of-service change, pleased the Chamber members. He credited recent extensive business lobbying efforts for some of the changes made in the Senate.

"I think we achieved some good success," Mehan said. "It's still not out of the woods yet."

Maxwell said the opposition didn't see eye-to-eye with the sponsors of the need for managed care reform.

"I think the industry had a difficult time dealing with this because they didn't understand the concerns of consumers," he said.