State mandates expand for external review, direct access

MANAGED CARE March 1999. ©1999 Stezzi Communications

Nine states passed mandates in 1998 for external review of coverage denials. Five states' new laws allow enrollees to appeal denials of coverage for both medically necessary procedures and investigational treatments. Also last year, nine states enacted direct-access laws, giving members of "gatekeeper" plans the right seek treatment from — depending on the state — chiropractors, ophthalmologists, dermatologists, and/or other practitioners. In 1998, more than half of the state legislatures debated HMO liability bills, but none passed.

SOURCE: BLUE CROSS BLUE SHIELD ASSOCIATION, WASHINGTON, 1999