Maryland Gov. Parris Glendening this month is expected to sign the nation's first bill mandating that HMOs offer a point-of-service option. Several other states are considering similar bills viewed as a backlash to managed care.
But the Group Health Association of America, the organization representing HMOs, believes it's "ahead of the game" in the battle against proposals to lessen HMO control over product offerings and provider contracts.
The American Medical Association and state medical associations are mounting "a concerted effort to introduce versions" of the model "Patient Protection Act" such as the Maryland bill, said Alphonso O'Neil-White, GHAA vice president and general counsel.
And last year 11 states passed "any-willing-provider" legislation, bringing the total of states that have such laws to 28, he said. The laws mandate that a managed-care network allow any physician who is willing to accept the network's standards and rate of pay to join. But such laws haven't been as successful this year, O'Neil-White said.
So far this year only one state-Arkansas-has passed an any-willing-provider law, and seven such bills were defeated, he said.
"I think our message is getting across to employers and business groups, who would bear the cost of such proposals," he said.
Maryland's law, however, would require individuals to pay the extra premium for the right to be treated by a non-network physician in a point-of-service plan. Several HMOs already offer POS options, without that requirement.
Only four of the states with any-willing-provider laws include physicians applying to HMOs. Those states are Arkansas, Idaho, Kentucky and Wyoming, and only Kentucky has significant HMO penetration, O'Neil said.
In states with high HMO penetration, legislators seem to be better versed in the requirements of managed care and are defeating any-willing-provider laws, he said.
Meanwhile, Maryland's bill, which mandates that an HMO offer an opt-out of its network, can be seen as "back-door any-willing-provider legislation," said Geni Dunnells, executive director of the Maryland Association of HMOs.
The bill also would require HMOs to respond within 30 days to a physician seeking to join their network.
Among other provisions, the bill also bans the practice of HMOs withholding a portion of physicians' fees unless quality and service targets are met.
The Maryland bill "sets up the possibility of a lot of litigation," because it establishes an adversarial relationship with providers, Dunnells said.
Glendening has until May 30 to sign the legislation.