Patient Access Bill Brought Before Congress

On April 23, 1997, the Patient Access to Responsible Care Act (PARCA) was introduced in the U.S. Congress. The bill would establish a set of national standards governing the conduct of health insurance plans, including managed care and self-insured ERISA plans, which are currently exempted from regulation at the state level. The bill also helps protect patients and providers who find themselves negatively impacted by managed health care plans.

The legislation was introduced in the Senate as bill number S 644 and in the House of Representatives as bill number HR 1415. Initial drafts were developed by the Coalition for Health Care Choice and Accountability. The Coalition, initially formed by the American Chiropractic Association, includes 31 different health care provider associations of all types, including nurses, surgeons, MDs and dentists. The ACA has maintained a leadership role in the Coalition.

The two most important elements of the proposed legislation are that all U.S. employees have access to a point of service plan (POS), and the prohibition against discrimination of providers "solely based on their license." POS plans have only been available over the last 10 years, but are becoming very popular, primarily because they allow enrollees the option of accessing a provider outside the network for a reasonable additional cost.

Introduction of the PARCA bill in the House was headed by Congressman Charlie Norwood (R-GA). At press time, there were 80 House members co-sponsoring the bill, including three important House committee chairmen: Bob Livingston, House Appropriations Committee (R-LA); Floyd Spence, House Armed Services Committee (R-SC); and Gerald Solomon, House Rules Committee (R-NY).

In the Senate, Alphonse D'Amato (R-NY) is sponsoring the legislation. The work over the past several weeks has been aimed toward obtaining original sponsors for the PARCA bill in the House, and the organizations that support the legislation are still in the early stages of building support for it in the Senate.

 

Key Points for Patients

Besides access to POS plans, the PARCA legislation would allow patients to:

• have prompt delivery of health services; select a health professional within a plan, change that selection if they feel it necessary, and be guaranteed continuity for health care services they receive;


• have access to specialized treatment when that treatment is "medically necessary in the professional judgment of the treating health professional";


• participate in a plan regardless of "race, gender, language, age, disability, health status, or anticipated need for services";


• have their views "considered in developing health plan policies, including policies governing coverage for treatment, utilization review, quality, and management of medical procedures";


• have access to clearly understandable information about the plan, including: benefits; the number and mix of network health professionals; out of network costs; grievance/appeals procedures; and to have that information published in a uniform format for easy comparison across all health plans.

Key Points for Health Professionals

Besides the prohibition against discrimination of providers "solely based on their license," the PARCA legislation mandates that health professionals:

• must be allowed to apply as a provider, and use meaningful standards in reviewing applications;


• cannot be discriminated against participation in a plan because of race, gender, age, disability (if disability does not impair the professional's ability to provide services), or lack of affiliation with a hospital;


• "must be considered in developing health plan policies, including policies governing coverage for treatment, utilization review, quality, and management of medical procedures";


• must be given a reasonable notice of termination from a plan, and allow for appeal;


• cannot be prohibited or limited from engaging in "medical communications regarding the patient's health status, medical care, treatment options, utilization review requirements, or financial incentives to deny or limit care";


• be given "fair and accountable utilization reviews, and timely payment of claims," and prevents plans from compensating utilization reviewers for denying care.

Enforcement of PARCA

PARCA will be enforced in the same way as the Kennedy-Kassebaum Health Insurance Portability Act. This bill allows states to enforce the provisions of this act for all non-self-insured plans. Because self-insured plans avoid state laws and to ensure single unified guidelines in the spirit of ERISA, guidelines for self-insured plans will be enforced by the federal government. States will be given the authority to pass additional requirements than are included in this bill for non-ERISA plans.

In addition to the impact the PARCA bill will have on health care plans if passed, it will likely be the only broadly-drafted managed care standards bill introduced in the GOP-controlled Congress which has Republican members of Congress as the legislation's principal sponsors.

What You Can Do

The House version of the bill is headed for the House Commerce Committee and the House Education and the Workforce Committee. The Senate version goes to the Senate Labor and Human Resources Committee.

Below is a state listing of the members of those committees and how to contact them. Take a moment to call, fax or e-mail your representatives with a message of your support, and encourage your family, friends and patients to do the same.

• = co-sponsor of the PARCA bill

HOUSE EDUCATION AND WORKFORCE COMMITTEE

Phone: (202) 225-4527 Fax: (202) 225-9571
http://www.house.gov/eeo/

California
Matthew D. Martinez (D-31)
Howard "Buck" McKeon (R-25)
George Miller (D-7)
Frank Riggs (R-1)
Loretta L. Sanchez (D-46)
Lynn Woolsey (D-6)

Colorado
Bob Schaffer (R-4)

Delaware
Michael Castle (R-at large)

Florida
Joe Scarborough (R-1)

Georgia
Nathan Deal (R-9)
Charles Norwood (R-10)

Hawaii
Patsy Mik (D-2)

Illinois
Harris W. Fawell (R-13)

Indiana
David McIntosh (R-2)
Tim J. Roemer (D-3)
Mark Souder (R-4)

Massachusetts
John F. Tierney (D-6)

Michigan
Peter Hoekstra (R-2)
Dale E. Kildee (D-9)
Joseph Knollenberg (R-11)
Fred Upton (R-6)

Missouri
William "Bill" Clay (D-1), Rnk. Mem.
James Talent (R-2)

Nebraska
Bill Barrett (R-3)

New Jersey
Robert E. Andrews (D-1)
Marge Roukema (R-5)

New York
Carolyn McCarthy (D-4)
Major R. Owens (D-11)
Donald M. Payne (D-10)

North Carolina
Cass Ballenger (R-10)

Ohio
Dennis J. Kucinich (D-10)

Pennsylvania
Chaka Fattah (D-2)
William F. Goodling (R), Chair
Jim Greenwood (R-8)
John E. Peterson (R-5)

Puerto Rico
Carlos Romero-Barcelo (D)

South Carolina
Lindsey Graham (R-3)

Tennessee
Harold E. Ford, Jr. (D-9)
Van Hilleary (R-4)

Texas
Ruben E. Hinojosa (D-15)
Sam Johnson (R-3)
Ron E. Paul (R-14)

Virginia
Robert "Bobby" C. Scott (D-3)

Wisconsin
Ronald J. Kind (D-3)
Thomas E. Petri (R-6)

HOUSE COMMERCE COMMITTEE
Phone: (202) 225-2927 Fax: (202) 225-1919
http://www.house.gov/commerce/

California
Brian Bilbray (R-49)
Christopher Cox (R-47)
Anna Eshoo (D-14)
James E. Rogan (R-27)
Henry A. Waxman (D-29)

Colorado
Diana L. DeGette (D-1)
Dan Schaefer (R-6)

Florida
Michael Bilirakis (R-9)
Cliff Stearns (R-6)

Georgia
Nathan Deal (R-9)
Charles Norwood (R-10)
Idaho
Michael Crapo (R-2)

Illinois
Elizabeth Furse (D-1)
J. Dennis Hastert (R-14)
John M. Shimkus (R-20)

Iowa
Greg Ganske (R-4)

Kentucky
Edward Whitfield (R-1)

Louisiana
W.J. "Billy" Tauzin (R-3)

Maryland
Albert Wynn (D-4)

Massachusetts
Edward J. Markey (D-7)

Michigan
John D. Dingell (D-16), Rnk. Mem.
Bart Stupak (D-1)
Fred Upton (R-6)

Missouri
Karen McCarthy (D-5)

New Jersey
Frank Pallone, Jr. (D-6)

New York
Eliot Engel (D-17)
Rick Lazio (R-2)
Thomas J. Manton (D-7)
Bill Paxon (R-27)
Edolphus Towns (D-10)

North Carolina
Richard M. Burr (R-5)

Ohio
Sherrod Brown (D-13)
Paul E. Gillmor (R-5)
Michael G. Oxley (R-4)
Thomas C. Sawyer (D-14)
Ted Strickland (D-6)

Oklahoma
Tom Coburn (R-2)
Steve Largent (R-1)
Pennsylvania
Jim Greenwood (R-8)
Ron Klink (D-4)

Tennessee
Bart Gordon (D-6)

Texas
Joe Barton (R-6)
Gene Green (D-29)
Ralph M. Hall (D-4)

Virginia
Thomas J. Bliley, Jr. (R-7), Chair
Rick Boucher (D-9)

Washington
Rick White (R-1)

Wisconsin
Scott Klug (R-2)

Wyoming
Barbara Cubin (R-at large)

SENATE LABOR AND HUMAN RESOURCE COMMITTEE
Phone: (202) 224-5375 Fax (202) 228-5044

Arkansas
Tim Hutchinson (R)

Conecticut
Christopher J. Dodd (D)

Indiana
Dan Coats (R)
Bill Frist (R)

Iowa
Tom Harkin (D)

Kentucky
Mitch McConnell (R)

Maine
Susan M. Collins (R)

Maryland
Barbara A. Mikulski (D)

Massachusetts
Edward M. Kennedy (D), Rnk. Mem.

Minnesota
Paul David Wellstone (D)

New Hampshire
Judd Gregg (R)

New Mexico
Jeff Bingaman (D)

Ohio
Mike Dewine (R)
Rhode Island
Jack Reed (D)

Vermont
Jim M. Jeffords (R), Chair

Virginia
John W. Warner (R)

Washington
Patty Murray (D)

Wyoming
Michael B. Enzi (R)

---

Thanking Our Friends

Listed alphabetically below are the congressional representatives who have introduced and sponsored the PARCA bill. Telephone numbers and e-mail addresses (not all representatives have e-mail!), have been included so that you may contact your representative and voice your appreciation of their support for this vitally important legislation. Please take the time to review this list, your voice is important.

Bill's Sponsers:

Rep. Charlie Norwood (R-GA)
Tel: (202) 225-4101
E-mail: ga10@hr.house.gov

Sen. Alphonse D'Amato (R-NY)
Tel: (202) 224-6542
E-mail: senator_al@damato.senate.gov

Bill's Co-Sponsors:

Rep. Spencer Bachus (R-AL)
Tel: (202) 225-4921

Rep. Richard H. Baker (R-LA)
Tel: (202) 225-3901

Rep. James A. Barcia (D-MI)
Tel: (202) 225-8171

Rep. Bob Barr (R-GA)
Tel: (202) 225-2931
E-mail: bbarr@hr.house.gov

Rep. Thomas M. Barrett (D-WI)
Tel: (202) 225-3571
E-mail: telltom@hr.house.gov

Rep. Sanford D. Bishop, Jr. (D-GA)
Tel: (202) 225-3631

Rep. Sherrod Brown (D-OH)
Tel: (202) 225-3401
E-mail: sherrod@hr.house.gov

Rep. Charles T. Canady (R-FL)
Tel: (202) 225-1252
E-mail: canady@hr.house.gov

Rep. Saxby Chambliss (R-GA)
Tel: (202) 225-6531
E-mail: saxby@hr.house.gov

Rep. Jon Christensen (R-NE)
Tel: (202) 225-4155
E-mail: talk2jon@hr.house.gov

Rep. Howard Coble (R-NC)
Tel: (202) 225-3065

Rep. Tom A. Coburn (R-OK)
Tel: (202) 225-2701

Rep. Michael "Mac" Collins (R-GA)
Tel: (202) 225-5901
E-mail: rep3mac@hr.house.gov

Rep. Larry Combest (R-TX)
Tel: (202) 225-4005

Rep. John Cooksey (R-LA)
Tel: (202) 225-8490

Rep. Robert E. "Bud" Cramer, Jr. (D-AL)
Tel: (202) 225-4801
E-mail: budmail@hr.house.gov

Rep. Danny K. Davis (D-IL)
Tel: (202) 225-5006

Rep. Thomas M. Davis (R-VA)
Tel: (202) 225-1492
E-mail: tomdavis@hr.house.gov

Rep. Nathan Deal (R-GA)
Tel: (202) 225-5211

Rep. Peter A. Defazio (D-OR)
Tel: (202) 225-6416
E-mail: pdefazio@hr.house.gov
Rep. Jay Dickey (R-AR)
Tel: (202) 225-3772
E-mail: jdickey@hr.house.gov

Rep. John J. Duncan, Jr. (R-TN)
Tel: (202) 225-5435
E-mail: jjduncan@hr.house.gov

Rep. Bob Filner (D-CA)
Tel: (202) 225-8045

Rep. Mark Foley (R-FL)
Tel: (202) 225-5792

Rep. John D. Fox (R-PA)
Tel: (202) 225-6111
E-mail: jonfox@hr.house.gov

Rep. Martin Frost (D-TX)
Tel: (202) 225-3605
E-mail: frost@hr.house.gov

Rep. Benjamin A. Gilman (R-NY)
Tel: (202) 225-3776

Rep. Lindsey O. Graham (R-SC)
Tel: (202) 225-5301

Rep. Gene Green (D-TX)
Tel: (202) 225-1688
E-mail: ggreen@hr.house.gov

Rep. Tony P. Hall (D-OH)
Tel: (202) 225-6465

Rep. Van Hilleary (R-TN)
Tel: (202) 225-6831
E-mail: hilleary@hr.house.gov

Rep. Earl F. Hilliard (D-AL)
Tel: (202) 22-2665

Rep. Maurice D. Hinchey (D-NY)
Tel: (202) 225-6335
E-mail: hinchey@hr.house.gov

Rep. William L. Jenkins (R-TN)
Tel: (202) 225-6356

Rep. Walter B. Jones (R-NC)
Tel: (202) 225-3415

Rep. Sue W. Kelly (R-NY)
Tel: (202) 225-5441
E-mail: dearsue@hr.house.gov

Rep. Patrick J. Kennedy (D-RI)
Tel: (202) 225-4911

Rep. Ron Kind (D-WI)
Tel: (202) 225-5506

Rep. Gerald D. Kleczka (D-WI)
Tel: (202) 225-4572
E-mail: jerry4w@hr.house.gov

Rep. Ray LaHood (R-IL)
Tel: (202) 225-6201

Rep. Ron Lewis (R-KY)
Tel: (202) 225-3501

Rep. John Linder (R-GA)
Tel: (202) 225-4272
E-mail: jlinder@hr.house.gov

Rep. Bob Livingston (R-LA)
Tel: (202) 225-3015

Rep. Carolyn B. Maloney (D-NY)
Tel: (202) 225-7944

Rep. Paul McHale (D-PA)
Tel: (202) 225-6411
E-mail: mchale@hr.house.gov

Rep. John M. McHugh (R-NY)
Tel: (202) 225-4611

Rep. David M. McIntosh (R-IN)
Tel: (202) 225-3021
E-mail: mcintosh@hr.house.gov

Rep. Constance A. Morella (R-MD)
Tel: (202) 225-5341

Rep. Sue Myrick (R-NC)
Tel: (202) 225-1976
E-mail: myrick@hr.house.gov

Rep. George R. Nethercutt, Jr. (R-WA)
Tel: (202) 225-2006

Rep. Frank Pallone, Jr. (D-NJ)
Tel: (202) 225-4671

Rep. Charles W. "Chip" Pickering (R-MS)
Tel: (202) 225-5031

Rep. Charles B. Rangel (D-NY)
Tel: (202) 225-4365
E-mail: rangel@hr.house.gov

Rep. Frank Riggs (R-CA)
Tel: (202) 225-3311
E-mail: repriggs@hr.house.gov

Rep. Marge Roukema (R-NJ)
Tel: (202) 225-4465

Rep. Bernie Sanders (I-VT)
Tel: (202) 225-4115

Rep. Joe Scarborough (R-FL)
Tel: (202) 225-4136

Rep. F. James Sensenbrenner, Jr. (R-WI)
Tel: (202) 225-5101
E-mail: sensen09@hr.house.gov

Rep. John B. Shadegg (R-AZ)
Tel: (202) 225-3361

Rep. Gerald B.H. Solomon (R-NY)
Tel: (202) 225-5614

Rep. Floyd Spence (R-SC)
Tel: (202) 225-2452

Rep. Fortney Pete Stark (D-CA)
Tel: (202) 225-5065
E-mail: petemail@hr.house.gov

Rep. Ted Strickland (D-OH)
Tel: (202) 225-5705

Rep. Edolphus Towns (D-NY)
Tel: (202) 225-5936

Rep. James T. Walsh (R-NY)
Tel: (202) 225-3701
E-mail: jwalsh@hr.house.gov

Rep. Zach Wamp (R-TN)
Tel: (202) 225-3271

Rep. J.C. Watts, Jr. (R-OK)
Tel: (202) 225-6165
E-mail: rep.jcwatts@mail.house.gov

Rep. Robert A. Weygand (D-RI)
Tel: (202) 225-2735

Rep. Roger F. Wicker (R-MS)
Tel: (202) 225-4306
E-mail: rwicker@hr.house.gov

Rep. Robert E. Wise, Jr. (D-WV)
Tel: (202) 225-2711
E-mail: bobwise@hr.house.gov

Rep. Lynn C. Woolsey (D-CA)
Tel: (202) 225-5161
E-mail: woolsey@hr.house.gov

As we go to press, nine more representatives have come onboard as co-sponsors of the PARCA bill:

Rep. John Elias Baldacci (D-ME)
Tel: (202) 225-6306
E-mail: baldacci@hr.house.gov

Rep. Barbara Cubin (R-WY)
Tel: (202) 225-2311

Rep. John T. Doolittle (R-CA)
Tel: (202) 225-2511

Rep. Bart Gordon (D-TN)
Tel: (202) 225-4231
E-mail: bart@hr.house.gov

Rep. Jim McDermott (D-WA)
Tel: (202) 225-3106

Rep. Susan Molinari (R-NY)
Tel: (202) 225-3371
E-mail: molinari@hr.house.gov

Rep. Nick J. Rahall II (D-WV)
Tel: (202) 225-3452
E-mail: nrahall@hr.house.gov

Rep. William M. "Mac" Thornberry (R-TX)
Tel: (202) 225-3706

Rep. Jim Turner (D-TX)
Tel: (202) 225-2401
E-mail: tx02@mail.house.gov

For further information on the PARCA bill and the impact it will have on the nation's health care system, please contact the American Chiropractic Association's government relations department at (703) 276-8800.