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By Ami Albernaz
One year ago, the United States Supreme Court's decision to uphold
Kentucky's broad "any willing provider" law briefly focused attention
on the issue in other states. However, the combination of a short
legislative session and more pressing priorities has resulted in
little change, at least in New England.
Any willing provider (AWP) laws, which prohibit health insurers
from excluding willing and qualified health service providers within
their geographic areas, are active in 21 states, although in most
cases, the laws apply only to pharmacies. The Kentucky case received
so much attention because the any willing provider provision there
applies to doctors, nurse practitioners, hospitals and other health
facilities.
In New England - where only Connecticut and Massachusetts have
pharmacy-related laws in place - efforts to get AWP legislation
passed have failed. In New Hampshire, where a few such bills were
proposed last year, all were defeated, with no new efforts made
this year.
In Massachusetts, AWP efforts have stalled since a limited bill
that would have allowed non-English speaking patients to seek a
provider out of their health networks was defeated. Elena Eisman,
Ed.D., executive director of the Massachusetts Psychological Association,
says that no attempt was made to get AWP legislation pushed through
this year.
Resistance to AWP amendments has come mainly from the insurance
industry, which maintains that such laws would raise administrative
costs and make it more difficult for quality of care to be monitored.
In some states, AWP laws have little practical effect because they
are superseded by terms of the federal Employee Retirements Income
Security Act (ERISA), which dictates how many employee health programs
are managed.
Those in favor of AWP privileges, meanwhile, believe they are important
for ensuring continuity and consistency of treatment. Frank Luongo,
Ph.D., a Portland, Maine psychologist, has had to stop seeing patients
who have switched jobs and insurance plans, and believes that an
any willing provider provision for psychologists would be in clients'
best interest.
"There's still difficulty in transitioning patients; some cannot
see their same provider," Luongo says. "It's pathetic." He adds
that he would like to see the AWP issue revisited in the near future,
although with the short legislative year, other issues including
a Medicaid shortfall have precedence.
Although many psychologists are in favor of AWP laws, not everyone
sees the need to fight for them. Daniel Abrahamson, Ph.D., director
of professional affairs for the Connecticut Psychological Association,
says that changes in psychologists' relationships with health insurance
providers have lessened some of the movement toward any willing
provider privileges.
Some psychologists have managed to opt out of managed care panels
and start successful private practices, while some health networks
have become less restrictive in admitting providers. Additionally,
"point of service" plans have given patients more options for providers.
Yet given the successes in Kentucky and other states with broad
any willing provider legislation, momentum toward getting such laws
passed in other states will only build, says Shirley Higuchi, J.D.,
assistant executive director for legal and regulatory affairs at
the American Psychological Association.
"Because of the Supreme Court's decision regarding Kentucky, states
will move forward on this," Higuchi says. "The decision will give
them support and energy, so they will be more motivated."
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