March 5, 2001 The Honorable Bill Frist 416 Russell Senate Office Bldg Washington, DC 20510 Dear Senator Frist: 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 the McCain/Kennedy/Ganske/Dingell bill. We were pleased that President Bush mentioned the Patients' Bill of Rights in his first State of the Union address and we appreciate his specific comment that a bill should have a solid provision regarding external review. 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. It has been reported that you (and a Senate Working Group) are working to craft a compromise between the McCain/Kennedy bill and the Bush Administration's set of guiding principles on this issue. We commend your efforts and hope your work will yield an agreement that will benefit every patient who may find him/herself in need of this important recourse. 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 cc: The reported Senate Working Group on the Patient's Bill of Rights: The Honorable John Breaux The Honorable Sue Collins The Honorable Jim Jeffords The Honorable Bill Nelson The Honorable Mary Landrieu The Honorable Judd Gregg