Carper-Bayh ‘Contract Compromise’ to Patients’ Bill of Rights Passes Senate, Amendment demands Reviewers Honor Patient-Provider Contracts

WASHINGTON, DC – Members of an independent medical review panel will not have the ability to override binding contracts between patients and their HMO provider under a bipartisan compromise amendment offered today by Senators Thomas R. Carper (D-DE), Evan Bayh (D-IN), and John McCain (R-AZ) that unanimously passed the Senate. The amendment clarifies the scope of health plans’ responsibility and provides greater certainty to patients before beginning the appeals process. HMOs will be held strictly accountable for providing patients every medically necessary procedure they have contracted to cover. Under the Carper-Bayh-McCain amendment, review boards may not mandate coverage that was not included in the original contract. “The Patients Bill of Rights as written leaves the door open to capricious actions by a medical review board. Unless amended, the bill gives reviewers the opportunity to void a contract between a patient and provider by demanding coverage explicitly denied within that contract,” Carper said. “Our amendment provides certainty for patients and health plans and eliminates the possibility of a reviewer abusing his or her discretion. I am pleased to stand with Senators Bayh and McCain to offer this amendment.” The bill received broad bipartisan support, passing with all 49 Republican votes. “What we’re trying to do is restore balance to the system. We don’t want to see costs spiral or employers cut coverage for their employees. At the same time, we want to ensure that patients get the kinds of protections and quality care they deserve,” Carper said. “This amendment helps strike that balance.”