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Finance issue brief: any willing provider.

M Stauffer

    Issue Brief (Health Policy Tracking Service)
    |November 10, 2000
    PubMed
    Summary

    Nearly half of US states mandate managed care organizations (MCOs) to contract with willing healthcare providers. These laws increasingly cover a wide range of professionals beyond just pharmacies.

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    Area of Science:

    • Health Policy
    • Healthcare Law
    • Managed Care

    Background:

    • Managed care organizations (MCOs) like health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are prevalent in healthcare.
    • State regulations increasingly influence MCO contracting practices.

    Observation:

    • A growing number of states have enacted "any willing provider" laws.
    • These laws compel MCOs to contract with healthcare providers who meet specified terms.

    Findings:

    • Approximately half of all states currently have some form of "any willing provider" legislation.
    • While initially focused on pharmacies and pharmacists, legislative scope has broadened.
    • Current legislation extends to a wider range of healthcare professionals, including hospitals, physicians, chiropractors, podiatrists, therapists, and nurses.

    Implications:

    • "Any willing provider" laws can impact MCO network adequacy and provider choice.
    • These regulations may influence healthcare costs and access to services.
    • The expansion of these laws suggests a trend towards greater provider negotiation power within managed care frameworks.

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