The Supreme Court recently ruled that states could pass laws forcing HMO's to open their networks to more healthcare providers, giving patients a broader choice of physicians and hospitals. This decision will force health maintenance organizations and self-insured programs to open up provider panels to out-of network physicians, pharmacists and others who agree to abide by an HMO's reimbursement rates and contract terms. States with "any-willing-provider" statutes may have a significant impact from this decision, sparking new discussions on an "any-willing- provider law" in Ohio.
The American Medical Association applauds the Supreme Court
Decision and believes that the decision provides patients and physicians with a major
victory. The decision grew out of a Kentucky case, Kentucky Association of Health
Plans vs. Mill, where Kentucky's "any willing provider" stature was challenged
by a group of HMO's and an industry trade association. The case cited whether
Kentucky's statutes regulate insurance, which are enforced by states; or employees
benefits, which are enforced by the federal government. The Supreme Court found in
favor of the states, which will now have, to open their provider networks as well.