June 4, 2001, Letter to Members of House of Representatives Urging Passage of Patients' Bill of Rights AHQA has endorsed the section of H.R. 526 which pertains to external appeals. It contains language that instructs the Secretary of Labor to give "deference" to entities that currently hold state and federal contracts for external review when setting up a certification process for the external appeals enteritis under the new law. This would provide for a simplified certification process for PROs who want to enter this new area of work. The section also requires reviewers to be "actively practicing" two days per week -- which AHQA has maintained appropriately narrows the field of applicants to those most highly qualified such as the PROs. AHQA sent the letter below to the following Members of the House of Representatives who have been identified by the Patients' Bill of Rights Coalition as those either needing encouragement to begin supporting or to continue supporting the bill -- or House Members that must use their leadership to get the bill passed. Each letter contained the name, address, phone and fax of the appropriate PRO for their state: Brad Carson (D-OK) Robert Cramer (D-AL) Gary Condit (D-CA) Jim Davis (D-FL) John D. Dingell (D-MI) Calvin Dooley (D-CA) Harold E. Ford (D-TN) Greg Ganske (R-IA) Dennis Hastert (R-IL) Tim Holden (D-PA) Ron Kind (D-WI) Richard Larsen (D-WA) John Larson (D-CT) Ken Lucas (D-KY) James Matheson (D-UT) Jim Moran (D-VA) Tim Roemer (D-IN) Michael Ross (D-AR) John Tanner (D-TN) Ellen Tauscher (D-CA) Jim Turner (D-TX) Spencer Baucus (R-AL) Bob Barr (R-GA) Sherwood Boehlert (R-NY) Mark Foley (R-FL) Rodney Frelinghuysen (R-NJ) Steve Horn (R-CA) Peter T. King (R-NY) Charles Norwood (R-GA) Jack Quinn (R-NY) Jim Saxton (R-NJ) Christopher Smith (R-NJ) June 4, 2001 Dear Representative ___________________ The American Health Quality Association (AHQA) represents the national network of Medicare Peer Review Organizations (PROs). The PROs are required by federal statute to be independent, confidential, physician-led organizations with medical and statistical expertise. Having this expertise, they also work in many areas outside of Medicare. One of those areas is performing independent external appeals for private non-ERISA health plans and employers in many states across the nation. On behalf of the PROs, we write in support of the independent external appeals procedures as they are drafted in Section 104 of the Ganske/Dingell bill (H.R. 526). It has been reported that the Senate version of this bill (S. 283) is likely to be considered by the Senate in the near future. We support this effort and urge you to support its subsequent passage in the House of Representatives. Throughout this debate, AHQA has maintained that a strong independent external appeals process is the centerpiece of any worthwhile patients' rights legislation. Appeals should be performed by practicing physicians, must be handled quickly, and must be subject to expedited timeframes should the health of a patient be deteriorating. We believe Section 104 meets these criteria. The PROs have great expertise in this area and under Section 104 they can become independent review entities in every state of the nation. This should help to assure the American public that experienced, state-based reviewers stand ready to hit the ground running from the moment the new law is implemented. The PRO in your state that can become an independent external review entity is: «PRO» Phone Number: «Phone» «Address_1» Fax Number: «Fax» «Address_2» «City», «State» «Zip» Thank you for your consideration of our position. If you have any questions, or would like additional information, please contact me. Sincerely, Sylvia Gaudette Director of Government Affairs The American Health Quality Association