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The President’s Advisory Commission on Consumer Protection and
Quality in the Health Care Industry was established in March 1997
to recommend measures to ensure health care quality and value and
to protect consumers in the health care system. The Commission
has issued their report, The Consumer Bill of Rights and
Responsibilities, and Federal agencies have been directed by an
Executive Memorandum to ensure that the rights contained in that
document become a reality for their constituents.
Implementation of the Consumer Bill of Rights has three
objectives:
- To strengthen consumer confidence by ensuring that the
health care system is fair and responsive to consumers’ needs;
- To strengthen the relationships between patients and their
health care providers; and
- To encourage consumers to take an active role in improving
their health.
The revised Clinical Section of the Health Center Program
Expectations requires that health centers implement the Consumer
Bills of Rights that are based on the provisions of the
Commission’s report as applicable to each center’s operations.
The following sections summarize each of the provisions and
outline steps that health centers should take to implement these
provisions. The full text of the Consumer Bill of Rights can be
downloaded from the Commission’s Web site.
Most implementation steps involve the provision of information to
health center patients. Such information may be provided to all
patients or may be posted at the facility as determined
appropriate by individual health centers. All information should
be provided in languages appropriate for health center patients.
Provision: Consumers have the right to receive accurate, easily
understood information to make informed decisions about their
health plans, professionals, and facilities. This information
should include:
- Health Plans: Covered benefits, cost-sharing, and
procedures for resolving complaints; licensure,
certification, and accreditation status; comparable measures
of quality and consumer satisfaction; provider network
composition; the procedures that govern access to
specialists and emergency services; and care management
information.
- Health Professionals: Education and board certification
and recertification; years of practice; experience in
performing certain procedure; and comparable measures of
quality and consumer satisfaction.
- Health Care Facilities: Experience in performing certain
procedures and services; accreditation status; comparable
measures of quality; and worker and consumer satisfaction
procedures for resolving complaints and community benefits
provided.
Implementation: In response to this provision, health centers
should compile and provide to their patients at least the
following information:
- Services available and fee schedules
- Accreditation status of the center
- Certification and years of practice for all providers
- Results of consumer satisfaction and quality of care studies
- Complaint and appeals processes
This information should be provided and updated in whatever
manner is deemed appropriate by each health center.
Health centers are also expected to work with the managed care
plans with which they contract to ensure that the required health
plan information is available to the health centers’ patients.
Provision: Consumers have the right to a choice of health care
providers that is sufficient to ensure access to appropriate
high-quality health care. To ensure such choice health plans
should provide:
- Adequate provider networks, ensuring reasonable proximity of
providers to the residences of their members.
- Access to qualified specialists, included specialists for
women’s services.
- Transitional care for consumers who are undergoing treatment
for chronic conditions or who are in the second or third
trimester of a pregnancy at a time that they involuntarily
change plans or at a time when a provider is terminated by
a plan. Such patients should be able to continue seeing
their current providers for up to 90 days, and those
providers must accept the plan’s rates as payment in full.
Implementation: While this provision is directed to managed care
plans, health centers that contract with managed care plans
should work with those plans to assess the adequacy of the plan’s
network in terms of primary care providers, access to emergency
and specialty services, and continuity of care for their enrolled
patients.
In addition, health centers are also expected to provide their
patients with information on which health plans they participate
in and on accessing their hospital and specialty referral
networks.
Provision: Consumers have the right to access emergency health
care services when and where the need arises. To ensure this
right, health plans should educate their members about the
availability, location, and appropriate use of emergency and
other medical services; cost sharing provisions for emergency
services; and the availability of care outside an emergency department.
Implementation: Health centers are expected to provide after
hours coverage and to ensure access to emergency services.
Health centers also are responsible for educating their patients
about the appropriate use of emergency services and to ensure
follow up by center clinicians.
Health centers are also expected to work with their contracting
health plans to monitor the availability of emergency services to
their enrollees.
Provision: Consumers have the right and responsibility to
participate in all decisions related to their health care.
Consumers who are unable to fully participate in treatment
decisions have the right to be represented by others. To ensure
this right, health care professionals should provide patients
with easily understood information and opportunity to decide
among treatment options consistent with the informed consent
process. To facilitate greater communication between patient and
providers, health care providers, facilities, and plans should
disclose factors that could influence treatment decisions and
ensure that provider contracts do not contain gag clauses.
Implementation: To implement this provision, health centers
should reexamine their practices for involving patients in their
treatment decisions and assure that all providers are aware of
and adhere to this requirement.
Provision: Consumers have the right to considerate, respectful
care from the health care system. Consumers must not be
discriminated against in the delivery of health care services,
and consumers who are eligible for coverage under a health plan
or program must not be discriminated against in marketing or
enrollment practices.
Implementation: Health centers are expected to maintain a core
staff of primary care clinicians with training and experience
appropriate to the culture and identified needs of the community
and health center users. The mix of services provided should also be responsive to the unique needs of the population served.
Provision: Consumers have the right to confidentiality of their
health care information and the right to review and copy their
own medical records and request amendments to their records.
Implementation: Health centers are required to have a medical
records system that documents patient care. Records must be
maintained for every patient and must be easily retrievable and
properly secured. As directed by this provision, health center
patients must be able to access, copy, and request changes to
their records.
Provision: All consumers have the right to a fair and efficient
process for resolving differences with their health plans, health
care providers, and the institutions that serve them. Internal
appeals systems should include a timely claims review process,
resolution of appeals, written notification of decisions, and a
process for resolving consumer complaints. Their external
appeals system should be available after consumers have exhausted
internal processes.
Implementation: Health centers are required to have written
policies and procedures for patient grievances. Health centers
should ensure that patients are aware of these policies and the
specific steps that they may take to file grievances.
Health centers should also provide their managed care patients
with information on the complaint and grievance systems of their
contracting managed care plans.
Provision: Consumers should be encouraged to assume reasonable
responsibilities related to their health and health care. These
include becoming involved in health care decisions, working with health care providers to carry out treatment plans, learning
about health plan coverage, and maximizing healthy behaviors.
Date issued: August 5, 1998
Page reviewed: November 16, 2006
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