Sparsely populated and lacking large employers, Idaho always has been small potatoes for managed-care companies. But the handful of HMOs doing business in the state will find the going even rougher starting July 1.
That's when a new state law goes into effect that will require them to pay for the care of enrollees who go out of the plans' provider network for healthcare services.
Idaho will become only the third state to pass a so-called "mandatory point-of-service" law. Georgia and Maryland did so last year, according to the American Association of Health Plans.
Idaho Gov. Phil Batt signed the measure into law in March after it sailed through the Idaho Legislature.
In addition to the mandated point-of-service provisions, the legislation also banned physician "gag clauses" and financial incentives to deny care and set up a grievance system to hear consumer complaints against HMOs.
And, like many pieces of anti-managed-care legislation allegedly designed to protect consumers, Idaho's law was authored by and introduced on behalf of physicians, led by the Idaho Medical Association.
In essence, the law ensures physicians will be paid for services rendered to plan enrollees even if the physicians aren't on a plan's participating provider roster. The law doesn't specify a minimum percentage of charges that must be covered.
The state's managed-care industry opposed the mandated point-of-service provisions in the bill, which it considered too intrusive.
The Washington-based AAHP, a national managed-care trade group, expressed the same sentiments. "Those employers who want to offer out-of-network benefits already have tremendous choice available to them," said spokesman Don White.
"It's a good bill that updates a 24-year-old statute, and it's bringing in many consumer protections that will not substantially alter the way we do business," said Tracy Andrus, vice president of public affairs for Blue Cross of Idaho. "But we have objected all along to mandatory point-of-service, not because it's a bad product, but because the Legislature is making the selection, not the person paying for it."
"It sets a dangerous precedent, with the government telling health plans what products they need to offer," said Angela Matson, legislative analyst for Spokane, Wash.-based Group Health Northwest, which has 11,000 managed-care enrollees in Idaho.
But supporters insist the law was crafted particularly to address the growing concerns of consumers.
"We still don't have a lot of managed care in Idaho, and people still read here, and they're seeing some of the problems people have with HMOs in other states. We're a little more independent here," said Robert K. Seehusen, executive director of the Idaho Medical Association. "This gives patients choice as to who their physicians and providers are."