EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

1-1 Whereas, On May 19, 1998, testimony was presented to members of

1-2 the United States Senate Committee on Labor and Human Resources by

1-3 the Honorable Marilyn R. Goldwater, Deputy Majority Whip in the

1-4 Maryland House of Delegates, urging members of Congress to strengthen

1-5 requirements for the appeals processes for plans covered by the Employee

1-6 Retirement Income Security Act of 1974 (ERISA); and

1-7 Whereas, In her presentation, Ms. Goldwater noted that it is important

1-8 to have strong, effective and responsive internal grievance and appeal

1-9 mechanisms in place; and

1-10 Whereas, Every state requires managed care entities to have an

1-11 internal appeals process in place; and

1-12 Whereas, If it is determined that a federal external appeals process is

1-13 appropriate, it should be administered by the Federal Government

1-14 according to rules established by federal law, with states managing those

1-15 plans under their regulatory authority; and

1-16 Whereas, Several states have enacted legislation to revise and refine

1-17 both the internal and external appeals processes; and

2-1 Whereas, In Maryland, legislation was enacted to strengthen the

2-2 state’s internal grievance and appeals processes, establish an external

2-3 appeal mechanism and provide additional regulatory authority to the state’s

2-4 insurance commissioner over medical directors in health maintenance

2-5 organizations; and

2-6 Whereas, In Florida, the nation’s first external review process was

2-7 created in 1985, and Florida continues to fine tune its process by utilizing a

2-8 panel of six state employees for the external review process, with explicit

2-9 time frames from "extreme emergency" cases to "nonurgent" cases; and

2-10 Whereas, New Jersey enacted legislation in 1997 that requires health

2-11 maintenance organizations to establish an external appeal process and now

2-12 operates a consumer hot line for consumer questions and complaints; and

2-13 Whereas, Texas enacted landmark legislation in 1998 that permits

2-14 managed care enrollees to sue their health plans for malpractice in cases

2-15 where they have been harmed by a plan’s decision to delay or deny

2-16 treatment; and

2-17 Whereas, According to The Best From the States II: The Text of Key

2-18 State HMO Consumer Protection Provisions by Families USA Foundation

2-19 (October 1998), key consumer protection provisions include the

2-20 establishment of explicit time frames for appeal of decisions,

2-21 implementation of methods for expediting the review of emergency and

2-22 urgent care situations, acceptance of oral appeals and adoption of laws that

2-23 require reviewers to be health care providers with expertise in the clinical

2-24 area being reviewed and that prohibits reviewers from participating in the

2-25 review of cases in which they were involved in the original decisions; and

2-26 Whereas, On February 9, 1999, in a letter to the editor of the Las

2-27 Vegas Sun, Marie Soldo, immediate past Chairman of the Nevada

2-28 Association of Health Plans, wrote that, because the state has limited

2-29 jurisdiction regarding the regulation of health insurance plans, more than

2-30 two-thirds of Nevadans, including state and federal employees, Medicare

2-31 and Medicaid enrollees and others whose employers are self-insured, are

2-32 not affected by state legislative action such as mandated benefits, improved

2-33 grievance and appeals processes and the proposed ombudsman office;

2-34 now, therefore, be it

2-35 Resolved by the Assembly and Senate of the State of Nevada,

2-36 Jointly, That the Nevada Legislature hereby urges Congress to take steps

2-37 to ensure that those plans which are exempt from state regulation provide

2-38 adequate protection provisions for persons covered by such health plans;

2-39 and be it further

3-1 Resolved, That the Chief Clerk of the Assembly prepare and transmit

3-2 a copy of this resolution to the Vice President of the United States as the

3-3 presiding officer of the Senate, the Speaker of the House of

3-4 Representatives and each member of the Nevada Congressional

3-5 Delegation; and be it further

3-6 Resolved, That this resolution becomes effective upon passage and

3-7 approval.