Politics & policy

Insight into federal and state health care legislation & CMS regulation

Massachusetts Governor Pushes HMO Reform Plan

Acting Gov. Paul Cellucci has offered an HMO regulation proposal he says will cover more people in Massachusetts than another bill under consideration.

Cellucci's bill would require HMOs to be accredited by the Department of Public Health. Plans would have to cover emergency services in situations that a "prudent lay person" would consider an emergency. The measure would also force plans to disclose physician compensation and set up procedures to resolve grievances and payment disputes. Plans would be barred from putting doctors at financial risk for the cost of treatments. The state would establish a managed care ombudsman to help people exercise their rights.

Cellucci says his bill would cover 700,000 more people than a plan crafted by the House committees on health care and insurance, because his proposal includes plans that contract with self-insured employers. The governor expressed willingness to craft a consensus bill that combines the two proposals. Legislative action is expected this month.

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