The health care industry is large, complex, and undergoing rapid change, making it difficult to estimate the effect of new requirements on the overall health care marketplace. Furthermore, several of the measure's provisions could have widely varying fiscal effects, depending on how they are implemented or interpreted by the courts. Effect of the Measure on Health Care Costs Generally Changes in health care costs have an impact on the state and local governments because of their role in directly operating health programs as well as purchasing health care services. The following provisions of this measure would increase health care costs generally. Currently, HMOs, health insurers, and other health care businesses may refuse to authorize recommended care that they believe to be unnecessary, unproven, or more expensive than an effective alternative treatment, without physically examining the patient.
Patients usually have a right to appeal such a denial.
The person conducting the examination would have to be a licensed health care professional with the expertise to evaluate the patient's need for the recommended care. Requiring a physical examination prior to denying care would increase general health care costs in two ways. First, health care businesses would have to add staff to provide additional examinations. Second, requiring an examination probably would result in some approvals of care that otherwise would be denied. The DHS would set, and periodically update, staffing standards for health care facilities that it licenses, such as hospitals, nursing facilities, and certain types of clinics.