“Any Willing Insurer” Legislation Introduced in Pennsylvania

By James M. Burns

A significant number of states have “Any Willing Provider” statutes that require a health insurer to admit all requesting providers into the health insurer’s preferred provider network. While some of these statutes are limited in scope (covering only pharmaceutical providers), others require insurers to admit any “willing” hospital or physician that meets the insurer’s credentialing standards into its network as well. However, in an unusual twist on these concepts, legislation was recently introduced in Pennsylvania that would require all hospitals in the state that are part of an integrated health system to contract with “any willing insurer.” If enacted into law, the legislation, H.B. 1621, would be the first of its kind in the country.

H.B. 1621 was introduced by Representatives Jim Christiana and Dan Frankel in the Pennsylvania Assembly in early October, and appears to be a legislative response to a public dispute between University of Pittsburgh Medical Center (the largest health system in Western Pennsylvania) and Highmark Blue Cross Blue Shield (the region’s largest commercial insurer). Specifically, UPMC has announced its intention not to remain in Highmark’s network beginning in 2014, a development that the bill’s sponsors contend would have adverse consequences for Pennsylvania citizens in terms of patient choice and healthcare access. Seeking to address this potential concern, H.B. 1621 would require that all hospitals operating as part of an integrated delivery network (which would include, but not be limited to, UPMC) contract with “any willing insurer” that desires to contract with it. In addition, the bill would prohibit such hospitals from requiring that the insurer agree to any contractual provisions that would restrict access to hospital facilities (i.e., steering provisions, anti-tiering provisions, etc.). Finally, the bill would also require the hospital to submit any dispute with the insurer over reimbursement rates to binding arbitration if the parties are unable to reach an agreement, with a default reimbursement rate being established in accordance with the rate paid by insurers under the Affordable Care Act to non-participating providers when providing emergency services (which, at least in most cases, would likely be less than that sought by the hospital).

While the introduction of H.B. 1621 may have been precipitated by the UPMC/Highmark dispute, if enacted, it would constitute a major shift in the contracting landscape for hospitals and insurers throughout Pennsylvania. Recognizing the significance of the bill, UPMC noted that “No state has ever enacted legislation that would require a hospital to give an in-network contract to whatever insurer wants one and on whatever terms the government or some outside party specifies,” and characterized the proposal as “regressive” and “anti-competitive.” While H.B. 1621’s prospects for passage are uncertain at this time, if “any willing insurer” legislation were to “catch fire” in the same way that “any willing provider” legislation has over the last ten years, provider/insurer contracting could be significantly impacted all across the country. Stay tuned.