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