The following article appeared in various forms in the Billings Gazette, Helena Independent Record, and Missoulian.
Legislative committee changes mind about good faith managed-care
rule
By ERICA CURLESS
Gazette State Bureau
HELENA - Lawmakers are putting their trust in a good-faith rule,
even though it may allow managed-care companies to sell insurance
in counties where no doctors or hospitals are participating in
the plan.
The interim Children, Families, Health and Human Services Committee
voted last week to keep the controversial rule that gives managed-care
companies the ability to compete in communities that refuse to
negotiate with health networks that include doctors and hospitals.
This decision reverses the committee's original move to stall the rule, which took effect Oct. 1 with the Managed-Care Adequacy and Quality Control Act passed by the 1997 Legislature.
"We chose not to take any further action," said the committee chairman, Sen. Mignon Waterman, D-Helena, adding that it may still result in some confusion.
And this possibility for confusion is why Rep. Bob Lawson, R-Whitefish, was the only member who voted against trying to revoke the rule.
"There still are some things in my mind that are not resolved," Lawson said, adding that the committee should have taken the opportunity to look into the situation.
Montana's managed-care law mandates that an insurance company must have providers, such as doctors, hospitals and a pharmacy, available within a 45-mile radius of where the health plan is offered.
At issue is the rule that waives this requirement if a managed-care company has made a good-faith effort to negotiate with local providers. The state has the ability to allow the managed-care company to still offer its plan if it determines the insurer has made a good faith effort to negotiate a contract.
But opponents argue the definition of a good-faith effort isn't clear.
The state said this exception rule is needed to keep managed-care companies from blocking competitors from offering health coverage to people. The idea is to give Montanans more access to affordable health coverage through competition, said Chuck Butler of Blue Cross Blue Shield of Montana.
But opponents, such as the Montana Hospital Association and Allied Citizens for Health Care Equity, argue that giving the department the authority to exempt managed-care companies from having a network within 45 miles of the community may force people to travel too far for health care.
Susan Good, Allied Citizens for Health Care Equity director, said problems will occur when businesses buy a health plan from a managed-care company that doesn't have any providers available in the community. That means the recipients of the health coverage, the employees, would have to travel more than 45 miles for care.
"It's buyer beware," Good said. "The person on the receiving end is usually the employees and they don't pick the health insurance.
But Denzel Davis, state Quality Assurance Division administrator, said it's not automatic the department would grant a waiver to a health-care network that has negotiated in good faith. He adds that the exemption gives a balance to the process.
Committee members said they wanted to give the rule time to work and if it didn't, lawmakers could revise it during the 2001 Legislature.
And Montana Care, a partnership between Blue Cross Blue Shield and the Great Falls Clinic that serves north central Montana, may try out the new rule next year, Butler said.
For two years, the managed-care company has unsuccessfully negotiated with the Northern Montana Hospital in Havre. The hospital is part of the New West Health Plan's network. Butler said the exemption rule is need specifically in cases like this where New West is locking out competitors and blocking Montanans from accessing affordable health coverage.
"We will make every effort to reach an agreement," Butler said. "And then give serious consideration to this opportunity."
--------------------------------------------------------------------------------
Updated: Tuesday, November 23, 1999
Copyright © The Billings Gazette, a division of Lee Enterprises.