Lawmaker seeks greater HMO disclosure.

Just days before last week's deadline to submit new legislation for the 1996 session, Sen. Herschel Rosenthal, D-Los Angeles, introduced two bills that would grant consumers considerably more leverage when dealing with health maintenance organizations.

SB 1732 would require HMOs to disclose to the state Department of Corporations details of any complaints lodged against them and how they spend premium dollars. The DOC would then publish those details in an annual "report card" of health plans. The report would also be available through the Internet, an interlinking series of computer networks and information storage sites accessible by modem.

Private organizations - such as the California Medical Association and the Pacific Business Group on Health - publish such information using data provided by the DOC, which oversees HMOs that operate in California. But the DOC itself does not publish the information in an easy-to-read format.

SB 1936 would require the department to establish an ombudsman department that would handle grievances from consumers having trouble receiving treatment from their HMOs. Those plans would also be proscribed from taking disciplinary action against any of its employees or network physicians who provides information to the DOC pertaining to a grievance.

Giving out useful info

"HMO patients often lack adequate information and assistance regarding their rights to health care and their remedies in the event they have a grievance," said Rosenthal, who is chairman of the Senate Insurance Committee.

The state's two major trade groups that monitor health care legislation, the California Healthcare Association, which represents physician groups and hospitals, and the California Association of HMOs, have yet to take positions on the legislation.

Sources have indicated HMOs will likely fight to kill or revise both pieces of legislation.

SB 1732 was spurred on in part by a recent state-by-state study by the Los Angeles-based consumer advocacy group Center for Health Care Rights, according to Rosenthal's office.

State leads

The study concluded that health plans and their regulatory bodies may be hesitant to expand publication of data pertaining to complaints and financial performance.

"Overall, California is ahead of most states (in terms of regulation)," said Peter Lee, director of the center's HMO consumer protection project. "They have more on the books, but whether something is enforced or not is a separate question."

Lee added that the DOC's consumer complaint hotline established late last year - and created by another piece of Rosenthal legislation, SB 689 - is not enough protection.

"The hotline does not provide any assistance in trying to choose a health plan, and it does not provide any help for someone filing a grievance either," Lee observed. "Instead, it serves only as an adjudicatory body, and is only for those who have been in their health plan grievance process for more than 60 days without a resolution."

Lee's group also supports the creation of an ombudsman system for consumers, but not through the DOC.

Instead, SB 1936 has the backing of another HMO watchdog, the San Francisco-based western regional office of Consumers Union.