EBSA Press Release: Labor Department Announces Initiatives to Implement President Clinton's Consumer Bill of Rights Directive [02/20/1998]

Archived News Release — Caution: Information may be out of date.

For more information call: (202) 219-8921

U.S. Labor Secretary Alexis M. Herman today announced three initiatives to implement President Clinton's Consumer Bill of Rights and Responsibilities directive to improve the quality and fairness of health care for millions of Americans.

Last November, the President directed the Departments of Labor, Health and Human Services, Defense, Veterans Affairs, and the Office of Personnel Management to assess ways to implement the bill of rights--prepared by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry--and then report back to him in February. Today, the President issued an executive order directing the departments to implement initiatives identified in the reports in order to come into compliance with the Consumer Bill of Rights.

"The Labor Department is deeply committed to the President's and Commission's goals of quality, fairness and responsibility in the selection and provision of health care services," Herman said. "As the Labor Department's analysis of the Bill of Rights indicated, federal legislation is necessary to ensure consumer rights. I look forward to working closely with the Congress to develop bipartisan legislative proposals to ensure that those rights are legally enforceable." Secretary Herman serves as co-chair of the Commission.

Herman announced that the department will undertake three major initiatives to advance the Consumer's Bill of Rights by:

• issuing new claims procedures to protect plan participants;
• expanding information and disclosure to plan participants; and
• offering guidance to clarify that plan fiduciaries must take quality into account when selecting service providers.

The Labor Department oversees approximately 2.5 million health plans sponsored by private sector companies and unions. These plans cover approximately 125 million workers, retirees and their families. The department's Pension and Welfare Benefits Administration (PWBA) is responsible for administering and enforcing Title I of the Employee Retirement Income Security Act (ERISA) which governs these plans.

The department will propose amendments to ERISA's regulations governing plans' internal claims procedures. This proposal will strengthen plans' internal appeals processes to ensure participants receive a fair and efficient benefits review. The proposal will also require that decisions regarding urgent care claims be resolved within not more than 72 hours, and that decisions regarding non-urgent care generally be resolved within 15 days. The proposed amendments also will require consultation with qualified medical professionals in deciding appeals involving medical judgments.

The department will propose amendments to ERISA's disclosure regulations to provide participants of group health plans with clear and understandable information. The proposed amendments will require plans to include such information in their summary descriptions consistent with the Commission's recommendations, including coverage of out-of-network services, conditions for access to speciality medical care, preauthorization and utilization review procedures.

In addition, the department recently issued guidance to plan fiduciaries clarifying that they have a duty to take quality into account when selecting health care service providers. When assessing the quality of services, fiduciaries may consider such issues as the scope of choices and qualifications of medical providers and enrollee satisfaction statistics.

Meanwhile, the Labor Department has implemented new procedures to expedite assistance to participants and beneficiaries seeking help with denied claims or services related to necessary emergency or medical care through its consumer assistance program. Each of the department's 15 field offices and national office in Washington, have trained personnel to assist with participant inquiries and requests for assistance. The general number in Washington for such assistance is (202) 219-8776.

Although ERISA currently protects health and pension benefits that employers voluntarily provide for their workers, the law focuses primarily on pension abuses and does not provide extensive standards for health plans. "Consequently," noted Assistant Secretary for PWBA Olena Berg, "DOL has been limited by the statute in its ability to ensure that ERISA-covered health plans have sufficient consumer protections."

ERISA and its regulations ensure that consumers in ERISA plans are provided with plan descriptions, an internal claims procedure to review and appeal consumer grievances regarding benefits and generally grants participants access to the plan document under which plans are operated. ERISA also prohibits plans from discriminating against consumers on the basis of health status.

Archived News Release — Caution: Information may be out of date.