130.994 “Willing Provider” Legislation:
MSSNY supports Federal and/or State legislation or regulation modeled after the recommendations contained in Report 25 of the American Medical Association adopted by the AMA at its 1993 Interim Meeting which report affirms: (1) The patient’s right to choose his or her physician. (2) The physician’s primary role as patient advocate. (3) The physician’s right to apply to any health plan or network and to have that application approved if it comports with physician-developed objective criteria based on professional qualifications, competence and quality of care. (4) That managed care entities and organizations and third party payers be required to disclose to physicians applying to a plan the selection 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. (5) That 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 and that no action be taken without due process. (6) That any federal effort to preempt state “any willing provider” laws be opposed. (7) Support for appropriate changes in relevant antitrust laws to allow physicians and physician organizations to engage in group negotiation with managed care plans.
MSSNY supports legislation that would protect physicians from dismissal from health care plans and/or the imposition of sanctions by health care plan administrators without due process, and will reach out to and seek the cooperation of ancillary providers and relevant consumer organizations to elicit their support of legislation and regulation which prohibits managed care entities and organizations, insurance companies or other similar organizations from unreasonably inhibiting provider access to their patients. (HOD 1994-57; Reaffirmed by Council 11/29/2012 in lieu of 2012-260; Reaffirmed HOD 2022)
