Bills Pass in Md. to Expand HMO Coverage

Article excerpt

The Maryland General Assembly has imposed a new round of health insurance coverage requirements on managed-care plans, including blood transfusions and diabetes treatment supplies and tests for prostate cancer and osteoporosis.

Consumer advocates hailed the new requirements. But both the Maryland House and Senate - responding to industry warnings about rising premiums - also passed bills to create the nation's first state review process to examine the economic impact of such mandates.

In all, the assembly considered 93 health insurance bills, joining states across the nation responding to consumer complaints that health care quality is eroding as employers shift to health maintenance organizations.

"New HMO laws or regulations were passed in 40 states in 1996," said Bill Erwin, a spokesman for Families USA, a consumer health care advocacy group.

The assembly responded to appeals from parents like Osama Farrag of Gaithersburg, who told the House Economic and Educational Opportunities Committee that his HMO would not pay for the $75-a-day blood transfusions that his infant son, Farris, depends on to live. Bills have passed both chambers requiring transfusion coverage by HMOs, imposing the same mandate that already exists for traditional fee-for-service insurance plans.

"The session turned out to be a good one for consumers of health care," said Miles Cole, director of business affairs for the Maryland Chamber of Commerce.

Gov. Parris N. Glendening is expected to sign the insurance mandate bills after the assembly session ends Monday. Bills that would require HMOs to cover minimum stays in the hospital for patients recovering from mastectomies and testicular cancer surgery were rejected at the committee level.

But some analysts say that the ability to control costs through managed care could be eroded by piling on coverage requirements. In a study released in November, the health care consulting firm Foster Higgins reported that health care benefits in Maryland represented 18 percent of total payroll expenses in 1995, compared with 9 percent nationwide. …