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Policy Compendium

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MAN-012: Willing Provider Provisions and Laws

 
Willing Provider Provisions and Laws: The Wisconsin Medical Society:

  • Acknowledges that health care plans or networks may develop and use criteria to determine the number, geographic distribution and specialties of physicians needed.
  • Will advocate strongly that managed care organizations and third-party payers be required to disclose to physicians applying to the plan the criteria used to select, retain or exclude a physician from a managed care plan, including the criteria used to determine the number, geographic distribution and specialties of physicians needed.
  • Will advocate strongly that those health care plans or networks that use criteria to determine the number, geographic distribution and specialties of physicians needed be required to report to the public, on a regular basis, the impact that the use of such criteria has on the quality, access, cost and choice of health care services provided to patients enrolled in such plans or networks.
  • Will advocate in those cases in which economic issues may be used for consideration of sanction or dismissal, the physician participating in the plan should have the right to receive profile information and education, in a due process manner, before action of any kind is taken.
  • Opposes any federal effort to preempt state “any [willing] [provider]” law.
  • Will continue to support the American Medical Association’s (AMA) “Legislative Specifications for Federal Regulation of Managed Care Plans.” (This policy was adopted by the AMA at the 1994 annual meeting.)
  • Believes that if a Managed Care Organization (MCO) terminates a contract mid-year of the plan with a provider that beneficiaries of that plan should be allowed to continue to see their provider for the rest of the year at in-network costs to the beneficiary or the beneficiary should be allowed to dis-enroll from the plan and enroll in another plan without restrictions and/or additional costs.
  • Believes that if MCOs terminate a contract, they must give written notice no less than two months prior to contract termination. (HOD, 0416)