U.S. Supreme Court Hands Down Major Victory To HMO Critics


In a historic and far reaching decision handed down by the United States Supreme Court on April 2nd, managed care plans can no longer impose discriminatory limitations on access to participation on the part of willing providers. This case, Kentucky Association of Health Plans v. Miller, 00-1471, was hotly contested by the managed care establishment, and despite the arguments of the managed care industry lawyers, the Supreme Court ruled unanimously that states can force HMOs to open up their doctor networks, upholding a practice used in about half the states to give patients broader health care choices.

The ruling is a shocking blow to the grip the managed care industry thought they had on the health care marketplace, and proved that their arguments, which centered on the assertion that closed networks are more cost-effective because doctors and hospitals that join agree to accept lower fees in return for a guaranteed stream of patients, were simply not convincing when held up against patient and provider rights of access.

ICA has had the passage of any willing provider laws on the top of its state legislative priority list for several years and encourages all state chiropractic communities in jurisdictions where this protection is not in place to mobilize to enact such a bill. ICA’s State Legislative Task Force, chaired by Dr. Donald Hirsh, has prepared an “Any Willing Provider Resource Book” to assist in such efforts.

The Supreme Court decision validates the so-called “any willing provider” laws passed by state legislatures requiring managed care networks or insurance companies to accept out-of-network health care providers, if in return, those providers agree to the insurer’s reimbursement rates and contract terms. The laws affect HMOs in all areas, but are particularly helpful to patients in rural areas or small towns, where health care choices are limited. In those areas, patient sometimes have to drive many miles to see an in-network health care provider. The Kentucky statutes were challenged by a group of HMOs and an industry trade association. The case turned on whether the laws regulate insurance, which states are allowed to police, or regulate employee benefits, an area reserved for Congress. The Bush Administration, in a somewhat unexpected turn, had asked the court to uphold the Kentucky laws.

Some Related Links:

FORBES: Supreme Court To HMOs: Come One, Come All
ABC NEWS: Court: HMOs Can Be Made to Open Networks – Supreme Court Says States Can Force HMOs to Open Doctor Networks, Giving Patients More Choices
CBS NEWS: Supreme Court Deals A Blow To HMOs

planetc1.com-news @ 11:33 am | Article ID: 1049826819