|A Patient Bill Of Rights
There is significant debate and even legal actions being taken around the country regarding what many professionals see as the erosion of professional ethics and the introduction of managed care policy. Professional organizations across the country have come together and developed a Patient Bill of Rights which is intended to educate both consumers and managed care. The following was developed in 1997 by Professional Organizations Representing 600,000 Mental Health & Substance Abuse Treatment Professionals.
These rights are not binding, but represent principles for discussion and patient advocacy.
Article on the Patient Bill Of Rights Professional Movement,
An Outline of Patient Rights
Our commitment must be to provide quality mental health and substance abuse services to all individuals without regard to race, color, religion, national origin, gender, age, sexual orientation, or disabilities.
Individuals have the right to be provided information from the purchasing entity (such as employer or union or public purchaser) and the insurance/third party payer describing the nature and extent of their mental health and substance abuse treatment benefits. This information should include details on procedures to obtain access to services, on utilization management procedures, and on appeal rights. The information should be presented clearly in writing with language that the individual can understand.
Individuals have the right to receive full information from the potential treating professional about that professional's knowledge, skills, preparation, experience, and credentials. Individuals have the right to be informed about the options available for treatment interventions and the effectiveness of the recommended treatment.
Individuals have the right to be informed by the treating professional of any arrangements, restrictions, and/or covenants established between third party payer and the treating professional that could interfere with or influence treatment recommendations. Individuals have the right to be informed of the nature of information that may be disclosed for the purposes of paying benefits.
Individuals have the right to receive information about the methods they can use to submit complaints or grievances regarding provision of care by the treating professional to that profession's regulatory board and to the professional association.
Individuals have the right to be provided information about the procedures they can use to appeal benefit utilization decisions to the third party payer systems, to the employer or purchasing entity, and to external regulatory entities.
Individuals have the right to be guaranteed the protection of the confidentiality of their relationship with their mental health and substance abuse professional, except when laws or ethics dictate otherwise. Any disclosure to another party will be time limited and made with the full written, informed consent of the individuals. Individuals shall not be required to disclose confidential, privileged or other information other than: diagnosis, prognosis, type of treatment, time and length of treatment, and cost.
Entities receiving information for the purposes of benefits determination, public agencies receiving information for health care planning, or any other organization with legitimate right to information will maintain clinical information in confidence with the same rigor and be subject to the same penalties for violation as is the direct provider of care.
Information technology will be used for transmission, storage, or data management only with methodologies that remove individual identifying information and assure the protection of the individual's privacy. Information should not be transferred, sold or otherwise utilized.
Individuals have the right to choose any duly licensed/certified professional for mental health and substance abuse services. Individuals have the right to receive full information regarding the education and training of professionals, treatment options (including risks and benefits), and cost implications to make an informed choice regarding the selection of care deemed appropriate by individual and professional.
Recommendations regarding mental health and substance abuse treatment shall be made only by a duly licensed/certified professional in conjunction with the individual and his or her family as appropriate. Treatment decisions should not be made by third party payers. The individual has the right to make final decisions regarding treatment.
Individuals have the right to receive benefits for mental health and substance abuse treatment on the same basis as they do for any other illnesses, with the same provisions, co-payments, lifetime benefits, and catastrophic coverage in both insurance and self-funded/self-insured health plans.
Individuals who use mental health and substance abuse benefits shall not be penalized when seeking other health insurance or disability, life or any other insurance benefit.
The individual is entitled to the entire scope of the benefits within the benefit plan that will address his or her clinical needs.
Whenever both federal and state law and/or regulations are applicable, the professional and all payers shall use whichever affords the individual the greatest level of protection and access.
To assure that treatment review processes are fair and valid, individuals have the right to be guaranteed that any review of their mental health and substance abuse treatment shall involve a professional having the training, credentials and licensure required to provide the treatment in the jurisdiction in which it will be provided. The reviewer should have no financial interest in the decision and is subject to the section on confidentiality.
Treating professionals may be held accountable and liable to individuals for any injury caused by gross incompetence or negligence on the part of the professional. The treating professional has the obligation to advocate for and document necessity of care and to advise the individual of options if payment authorization is denied.
Payers and other third parties may be held accountable and liable to individuals for any injury caused by gross incompetence or negligence or by their clinically unjustified decisions.
American Association for Marriage and Family Therapy (membership: 25,000) Anthony Jurich, Ph.D., President
American Counseling Association (membership: 56,000) Gail Robinson, Ph.D., President
American Family Therapy Academy (membership 1,000) Evan Imber-Black, Ph.D., President
American Nurses Association (membership: 180,000) Beverly L. Malone, Ph.D., RN, President
American Psychological Association (membership: 142,000) Dorothy W. Cantor, PsyD, President
American Psychiatric Association (membership: 42,000) Harold I Eist, M.D., President; American Psychiatric Nurses Association (membership: 3,000) Nancy M. Valentine, President
National Association of Social Workers (membership: 155,000) Jay J. Cayner, ACSW, LCSW, President
National Federation of Societies for Clinical Social Work (membership: 11,000) Elizabeth Phillips, Ph.D., President
National Mental Health Association
National Depressive and Manic-Depressive Association
American Group Psychotherapy Association
American Psychoanalytic Association
National Association of Drug and Alcohol Abuse Counselors
In 1997, leaders of nine organizations representing more than 600,000 health and mental health professionals issued a "Bill of Rights" to protect individuals seeking treatment for mental illness and psychological and substance use disorders. The documents reflects the joint concern of mental health professionals that people with psychological disorders, mental illnesses and substance use disorders are not being well-served in today's rapidly changing health care system.
The Bill of Rights marks the first time that diverse professional organizations have come together to develop a shared set of principles that declare Americans' right to quality mental health care. The principles cover the individual's right to full information about an insurance or managed care plan, confidentiality, choice of mental health professional, insurance equal to that available for other illnesses, a role in determining treatment, and plan accountability. The principles will be sent to all health and managed care organizations, consumer groups, and to every member of Congress.
"As mental health professionals, we have dedicated ourselves to the welfare of our patients," said Harold I. Eist, M.D., President of the American Psychiatric Association. "Yet every day in our offices, we see the harm caused our patients who frequently are denied the care they need by managed care or insurance plan representatives who have never seen them, patients whose confidential medical records are not treated with respect, and who often are not told of all the treatment options available to them - all in the name of controlling costs which regularly turns out to be making profits at the expense of patients. We hope that people will use the principles embodied in this Bill of Rights to demand and receive the care they need."
Added Dorothy Cantor, Psy.D., President of the American Psychological Association, "The present obsession of today's health care system on controlling costs is compromising the rights of individuals to competent and quality care. The principles embodied in those Bill of Rights reflect what we as professionals believe individuals are entitled to when they select a health plan and when they seek treatment. We are pleased that major national patient advocacy groups agree, and have given us their moral support."
The Bill of Rights initiative has been commended by the National Mental Health Association, the National Depressive and Manic Depressive Association, and the National Alliance for the Mentally Ill. These organizations are part of a National Managed Care Consortium which last year developed a very similar Bill of Rights for people in need of mental health services.
"We are very pleased that the major mental health professional groups were able to find common ground and develop these principles which complement the National Managed Care Consortium's Core Values and Principles, "said Mike Faenza, President and Chief Executive Officer of the National Mental Health Association who headed the consortium. "I congratulate the professional groups on their unprecedented accomplishment. Most importantly, we look forward to working with them. It is crucial that consumers, families and other advocates are the policy-making table to insure that behavioral health care reforms are good for children and adults with mental disorders," added Faenza.
Commending the Bill of Rights in a letter to Dr. Eist, Laurie M. Flynn, Executive Director of the National Alliance for the Mentally Ill, said: "There has never been such a consensus document; it is a breakthrough. It is healthy for consumers and providers to speak in closer harmony in opposition to health system provisions that impede access, or reduce quality and consumer satisfaction."