Executive Memorandum: Providing Patient Protections Through Final Regulations on Internal Appeals and Information (11/4/00)
                              THE WHITE HOUSE

                       Office of the Press Secretary
                           (Chappaqua, New York)

For Immediate Release                            November 4, 2000

                                 November 4, 2000


SUBJECT:       Providing Patient Protections Through Final
               Regulations on Internal Appeals and Information

In 1997, I appointed you and Secretary of Health and Human Services, Donna
E. Shalala, to co-chair the Advisory Commission on Consumer Protection and
Quality in the Health Care Industry (the "Quality Commission").  Through
the extraordinary efforts of you and Secretary Shalala in bringing together
a broad and diverse group of commission members, the Quality Commission
identified numerous shortcomings related to consumer protections in the
Nation's frequently evolving health-care delivery system.

Among numerous problems within the health-care delivery system, the Quality
Commission specifically cited that tens of millions of Americans with
private health insurance do not have access to a fair and timely appeals
process.  More specifically, under the Employee Retirement Income Security
Act (ERISA), 130 million Americans with employer-sponsored health plans
lack the pro-tection of a mean-ingful internal appeals process when plans
deny benefits for health care.  Health plans making benefit decisions often
do not have the medical expertise to make such decisions and appeals of
these decisions can take as long as 300 days.  As a consequence, countless
Americans have been harmed by inappropriate delays and denials of benefits.

The Quality Commission recommended that the benefit appeals and information
shortcomings, which hurt American patients and their families, be addressed
through a Consumer Bill of Rights.  Such improvements were an important
element of a broader array of patient protections including a right to see
a specialist, a right to receive emergency care, and a right to continue
ongoing medical treatment without disruption.  Since the release of the
Quality Commission's findings, my Administration has been working with a
bipartisan group of Members of Congress who are committed to enacting these
and other critical pro-tections, such as holding health plans accountable
when they take actions that injure patients.

As we have worked to pass a bipartisan, enforceable Patients Bill of
Rights, you have held public hearings that confirmed the need for a wide
range of protections, with a particular focus on those protections my
Administration can extend by executive action:  a fair and timely process
for internal appeals and meaningful information disclosure to consumers.
With my con-currence, you have not implemented these protections because of
our mutual belief that it would be far better to establish them in the
context of broader protections that would be included should the Patients
Bill of Rights be passed by the Congress.  Unfortunately, it now appears
clear that this Congress will not pass a meaningful and enforceable
Patients Bill of Rights this session.  With this in mind, I hereby direct
as follows:

You shall in the next 2 weeks promulgate final regulations protecting
millions of individuals with employer-based health coverage.  The
regulations shall establish a fair and unbiased process for reviewing
medical benefits claims, require timely coverage and appeal decisions, and
direct plans to provide meaningful information to patients advising them of
their rights to the appeals process.

This memorandum is not intended to create any right or benefit, substantive
or procedural, enforceable at law or equity by a party against the United
States, its agencies, or instrumen-talities, or any other person.

                              WILLIAM J. CLINTON

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