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4 Bills Curbing HMOs Signed

Health: The regulations approved by Davis, which largely fine-tune earlier reforms, address drugs, quality of care, coverage and grievances.

September 23, 2002|JEFF GOTTLIEB | TIMES STAFF WRITER

Gov. Gray Davis signed four bills Sunday aimed at strengthening HMO reforms enacted earlier in his administration.

The laws ensure that health maintenance organizations will not deny drugs to patients with serious illnesses; give the state Department of Managed Health Care authority to regulate HMOs' quality of care; provide health coverage through a state insurance program for those with existing conditions; and require HMOs to accept patient grievances over the Internet.

"The days when an HMO could deny patients drugs they needed to stay alive are over," said Daniel Zingale, director of the Department of Managed Health Care. "The days are over when they could make patients wait and wait for health care."

Much of the new legislation was aimed at fine-tuning laws to restore their original intent after the industry had fought them in court.

A bill by Assemblywoman Rebecca Cohn (D-Saratoga), for example, would put into law the health-care department's authority over quality of care, not just the financial stability of HMOs.

Cohn pointed to the case of Margaret Utterback, 74, of San Leandro in Northern California, who suffered a fatal aneurysm in January 1996 after waiting hours to see a doctor at Kaiser Permanente.

As a result, Kaiser, the state's largest HMO, was fined $1.1 million. An administrative law judge earlier this year struck down the fine, saying state law did not give Zingale's department oversight over the quality of medical care. But Zingale, who has the power to reject the judge's decision, reinstated the fine. Kaiser can appeal to the Department of Managed Health Care and then sue in Superior Court.

Cohn's bill also requires the department to adopt regulations for timely access to care by January 2004.

Cohn said the HMO industry opposed the bills Davis signed Sunday. "There will always be resistance to change because they don't want to be held accountable," she said.

Representatives of HMOs could not be reached Sunday.

Another bill, sponsored by Assemblywoman Helen Thomson (D-Davis), a nurse, would provide insurance for about 4,000 people who could not get health insurance because of existing medical conditions.

Beth Capell of Health Access California, a coalition of community, consumer and labor groups, said the majority of those affected are 50 to 65, most of them women, who had lost their health coverage because a spouse had died or had lost a job.

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