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Finance issue brief: any willing provider: year end report-2003
Issue Brief (Health Policy Tracking Service)
|February 19, 2004
Summary
Nearly half of US states mandate managed care organizations (MCOs) to contract with willing healthcare providers. These laws, often covering pharmacies, increasingly extend to hospitals, physicians, and nurses.
Area of Science:
- Health Policy and Law
- Managed Care
- Healthcare Provider Networks
Background:
- Managed care organizations (MCOs), including health maintenance organizations (HMOs) and preferred provider organizations (PPOs), are prevalent in healthcare.
- State regulations increasingly influence MCO contracting practices with healthcare providers.
Purpose of the Study:
- To analyze the scope and prevalence of state laws mandating MCOs to contract with any willing healthcare provider.
- To identify the types of healthcare providers covered by these "any willing provider" (AWP) statutes.
Main Methods:
- Review of state legislation and statutes concerning managed care contracting.
- Analysis of the types of healthcare providers and MCOs addressed in AWP laws.
Main Results:
- Approximately half of US states have enacted AWP laws.
- Initial AWP laws primarily targeted pharmacies and pharmacists.
- Recent legislative trends show broader application, encompassing hospitals, physicians, chiropractors, therapists, and nurses.
Conclusions:
- "Any willing provider" laws represent a significant regulatory trend impacting MCO networks.
- The expansion of AWP statutes broadens provider access and challenges traditional MCO network management.
- State-level AWP legislation creates a complex regulatory environment for healthcare providers and MCOs.