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States ponder
'any willing provider' statute
(May 2003
Issue)
By Ami Albernaz
In the wake of an April 2 Supreme Court ruling that allows states
to force HMOs to open themselves to any providers willing to abide
by their terms, several New England states are re-visiting the so-called
"any willing provider" issue.
The ruling upheld Kentucky's any willing provider (AWP) law, considered
to be the broadest in the country. While close to half of the states
have some form of AWP legislation on the books, most apply only
to pharmacies. Kentucky's law, meanwhile, is applicable to doctors,
hospitals, nurse practitioners and other health facilities.
In New England, where AWP laws are either non-existent or very
narrowly defined, some state psychological associations do not anticipate
much of an impact from the Supreme Court ruling. However, others
- such as New Hampshire - have decided it is time to try to open
the provider networks in their own states.
"The [New Hampshire Psychological Association] will strongly support
the any willing provider concept," says Kirsten L. Singleton, executive
director of the NHPA. The association's legislative committee recently
decided to submit AWP legislation in the next session; meanwhile,
according to Singleton, an AWP amendment is currently being heard
in the state Senate.
"It is not yet clear whether this amendment will be accepted by
the Senate," Singleton says, "but if so, there is a large coalition
of psychologists, mental health professionals and other health care
professionals which would likely strongly support this effort."
Nationwide, the debate over any willing provider legislation is
seen in terms of choice versus cost, with those in the insurance
industry saying that such laws raise administrative costs and make
it more difficult for HMOs to monitor quality of care. Psychologists
in favor of AWP laws, meanwhile, say that the laws are fundamental
for maintaining continuity of care.
Frank Luongo, Ph.D., a psychologist in Portland, Maine says that
he treated patients who then discontinued after changing jobs because
of restrictions on their new insurance plans.
"I've had patients willing to see me, and I've been willing to
accept their company's reimbursement rates, but because I'm not
a member of the new provider networks, the networks say, 'no way,'"
Luongo says. He adds that such restrictions lead to a "total discontinuity
of care," and that he would support an AWP law for his state.
"I'm very hopeful that we can launch a substantial effort to pass
any willing provider legislation in Maine," he says.
In Massachusetts, meanwhile, far-reaching any willing provider
legislation in the wake of the Supreme Court ruling does not seem
likely, says Elena Eisman, Ed.D., executive director of that state's
psychological association.
"It doesn't seem likely in this legislature," she says, "given
the budget situation and the financial implications for businesses."
The state has in place, however, any willing provider legislation
that applies to pharmacies. Under the law, HMOs by law must contract
with any pharmacy willing to meet their prices.
Eisman adds that a linguistic competence bill will likely take
effect this year; under that bill, if there is no one in a network
who speaks a patient's language, an outside provider can be sought,
who must be reimbursed at the managed care rate.
In Connecticut, where there is no AWP law on the books, the Supreme
Court ruling is not expected to bring about any change in the state,
at least in the foreseeable future.
"There was some effort in the past [to pass any willing provider
legislation], but interest has waned in the past several years,"
says Daniel Abrahamson, Ph.D., director of professional affairs
for the Connecticut Psychological Association. The reasons for this
stance, he adds, include a significant number of mental health professionals
opting out of managed care panels and succeeding in building practices
independent of the panels; an increase in health plans that provide
a "point of service" option; and that provider networks have become
less restrictive admitting providers.
"Some [mental health professionals] are still trying to get on
panels, but it's not like it was six or seven years ago," he says.
Yet even while there has been no call for change within the past
few years, Abrahamson admits that this is subject to change. "Health
care is a fickle environment," he says. "It changes so rapidly."
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