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Law Opens MCO Panels To `Any Willing Provider'

Mental health advocates hail the latest, and surprisingly unopposed, expansion of "any willing provider" laws into Vermont.

Among the first "any willing provider" measures aimed specifically at mental health clinicians, a recently enacted vermont law mandates that insurers provide identical reimbursement, regardless of whether treatment is provided by a member of its provider network.

The measure was hailed by vermont mental health advocates as the latest refinement of the state's 1997 mental health parity law, which required insurers to provide comparable coverage for mental and other medical conditions. In the years since approval of that legislation, the state's mental health clinicians found managed care networks effectively limited mental health care for many residents by not covering the services of established clinicians for patients new to the insurance network.

"These days insurance coverage often changes when people change jobs or move, so people often lose access to their mental health or substance abuse health care provider because they are not in the new insurer's [provider] network," said ken Libertoff, director of the vermont Association for Mental Health. "By passing this legislation, vermont reaffirms the right of health care consumers to receive treatment from practitioners of their choice as long as they are licensed and certified by the state of vermont."

Research indicates that in mental health care, the relationship between the patient and clinician is an important variable in effective treatment, Libertoff said.

Patient Choice Preserved

Supporters described the bill (H 404) as part of a series of initiatives designed to preserve patient choice and ensure access to necessary and appropriate treatment options. The measure passed after a collaborative legislative push by state professional associations—including the vermont Psychiatric Association and vermont Medical Society—and the major patient advocacy groups.

The measure's brief language requires health insurance plans to include in their networks "any licensed mental health or substance abuse [care] provider located within the geographic coverage area of the health benefit plan if the provider is willing to meet the terms and conditions for participation established by the health insurer."

"This bill was a response to concerns about access to comprehensive treatment for people with mental illness and substance abuse disorders," said David Fassler, M.D., legislative representative for the vermont Psychiatric Association and a member of APA's Board of Trustees. "It eliminates the use of restrictive or closed panels by insurance companies and/or their managed care intermediaries."

Supporters said the need for the measure was found in estimates that 20 percent to 30 percent of the state's population had a diagnosable mental health condition, but only 7 percent received treatment, which indicated the presence of barriers to care.

The law, effective July 1, allows psychiatrists or mental health professionals to join a network or provider panel if they are willing to accept the same terms and conditions applicable to other participants. The requirement that clinicians agree to insurers' terms related to care and fees has caused some consternation among physicians over similar laws in other states.

Short-Term Impact Unclear

The law may have some negative impact on in-network mental health care clinicians in the short term because it eliminates any clinician or insurer monopolies on who gets to treat patients, Libertoff said.

However, over the long term the measure will benefit patients, who have been forced to pay out of pocket to continue receiving care from the same clinician after they switched insurers.

The bill easily passed both chambers and faced no formal opposition from insurers, which vigorously opposed broader any-willing-provider measures in other states. The industry's opposition culminated in the 2003 Supreme Court decision in Kentucky Association of Health Plans v. Miller, which found any-willing-provider state laws were not barred under the federal Employee Retirement Income Security Act of 1974 (ERISA). Insurers had argued that such laws were barred by ERISA, which preempts state laws regarding employer-provided health plans.

Although no vermont insurers responded to calls from Psychiatric News, supporters of the law credited their lack of opposition to the broad support for the measure, the state's progressive politics, and early support from vermont Gov. Jim Douglas (R). Douglas signed the measure on May 4.

Opponents of more general any-willing-provider laws in other states have argued that the measures would increase costs and reduce coverage options for consumers by limiting health plans' ability to negotiate with clinicians for discounted rates. Disruptions to insurers' provider networks would also disrupt their quality controls for clinicians, insurers have insisted.

Quality-control measures by insurers, Libertoff said, have been found to be largely perfunctory, with few detailed examinations of the quality of care given by individual clinicians.

Supporters of the bill highlighted statistics showing that the state's largest managed behavioral health panel represented fewer than 50 percent of licensed clinicians in the state, and other panels represent even fewer. They also pointed out that there are no comparable panel restrictions for primary care physicians.

A copy of the law is posted at <www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/acts/ACT129.HTM>.

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