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January 09, 2002
Davis Would Require HMOs to Cover AIDS
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In 1999, Davis signed the Standing Referral Law, which created the California Department of Managed Health Care. The department oversees a system of external independent reviews when a patient's HMO denies treatment.
The law required managed care companies to provide HIV patients with access to specialists, but it did not provide criteria to define an HIV specialist, according to the Associated Press.
"We found that some of the HMOs were using the lack of a clear definition of an HIV/AIDS specialist to send those patients to people who are not qualified," said Daniel Zingale, director of the managed health care department.
HMOs sometimes referred patients to an infectious disease specialist who had never seen or treated an AIDS patient, he said. Zingale said the proposed changes would essentially mandate two requirements:
* That doctors designated as HIV/AIDS specialists by their HMOs have a minimum amount of current, up-to-date clinical experience in treating such patients.
* That those specialists maintain their knowledge through a defined demonstration of continuing education in the field.
"The governor felt we needed more authority, or at least a clear definition, to enforce the authority we have in that area," Zingale said.
The guidelines, which would become effective July 1, were drafted in cooperation with the American Academy for HIV Medicine in Los Angeles.
The AP reported that at least one medical services provider praised the new regulations but also urged HMOs to adopt the initiative themselves.
"We want the HMOs to stop the excuses and start saving lives," said Cesar Portillo, a spokesman for the L. A.-based AIDS Healthcare Foundation. "The HIV specialist's ability to prescribe the right medication at the right time makes the difference between life and death."
The governor's statement Sunday came on the first anniversary of the California patient's bill of rights program.
Since its inception, the agency has reviewed more than 600 appeals cases, and overturned the HMOs decisions for treatment in more than one-third of those, according to the governor's office.
To read the Associated Press article, click here.
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