Despite a growing number of lawsuits challenging the federal Employee Retirement Income Security Act (ERISA) preemption of state laws regulating managed care, ERISA continues to prevent many state laws from protecting patients against wrongful or negligent injuries. Federal legislation amending ERISA to grant patients uniform rights remains incomplete and controversial. This presentation analyzes the gaps left by ERISA preemption of state legislation and the prospects for federal legislation to remedy those gaps, with emphasis on laws requiring independent review of managed care decisions and liability for negligence, benefit denial, and determinations of medical necessity.
Learning Objectives: The participant in this session will be able to: 1. recognize ERISA’s effect on state laws defining and enforcing patient rights in managed care 2. compare federal and state approaches to defining and enforcing patient rights in managed care 3. assess specific proposed federal legislation and its probable effect on remedying the gaps in the enforcement of patient rights in managed care
Keywords: Accountability, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.