Health care lobbyists stay busy during session.

Any-Willing-Provider Law Revamped; Mental Health Parity Change Delayed

Health care legislation, for the most part, took a backseat to electric deregulation, highway improvements and property tax reform during the 1999 General Assembly session.

Still, from proposals affecting a patient's choice of physicians to a measure requiring insurers to treat mental health claims the same as other claims, there were several contentious health care issues.

In a session that saw legislators pass a record number of bills, health care lobbyists were especially active.

Lynn Zeno, director of governmental affairs for the Arkansas Medical Society, says he tracked more than 160 bills - some appropriations, some public health policy. The session was generally good for health care, he said.

The focal point of the health care debate in the session highlighted the differences in concerns of health insurers and those being insured.

Referring to his mission as an advocate for patients and the medical community during the session, Zeno cites two health care issues as most important: proposed changes to the "any-willing-provider" section of the state's Patient Protection Act, and the setting of a deadline for payment of uncontested insurance claims. An amended version of the any-willing-provider legislation received final approval in the waning days of the session, while Zeno says the "prompt payment" bill was bottled up in committee.

House Bill 1703 was an attempt, Zeno says, to revamp the 1995 any-willing-provider legislation that was struck down in federal court. The proposal tried to tighten wording on who was covered by the bill and excluded any mention of the federal Employee Retirement Income Security Act (ERISA), which was among the reasons cited by U.S. District Judge James Moody invalidating the 1995 law. Moody's ruling was later upheld in the 8th District Court of Appeals at St. Louis.

The measure would prevent insurers and state-licensed health maintenance organizations from excluding qualified health care providers who are willing to accept the insurer's terms and conditions.

Proponents of any-willing-provider legislation said the bill increased a patient's ability to choose his or her own doctor. Opponents, mainly insurers and employers, raised the fear of spiraling administrative and claims costs by requiring each willing doctor to be credentialed - which, they said, would ultimately erode the savings of managed care.

"The original bill was an effort to maintain the cost savings of managed care while allowing any qualified provider who agrees to the terms of the insurance contractor to participate," Zeno says.

Kenneth Hall, vice president for government affairs at the Arkansas State Chamber of Commerce, says the group tried to stay neutral on the measure but was concerned about the potential costs involved.

HB 1703, with 86 House co-sponsors and 15 Senate co-sponsors, garnered near-unanimous House support. In the Senate Insurance and Commerce Committee, Zeno says, insurance industry influence, combined with lobbying by groups such as the state chamber, prompted a late amendment that ultimately allowed passage.

The amendment required insurance plans to allow patients the option of paying an additional premium or higher co-pay amount to use a physician outside the plan's network.

Zeno calls the final version "a start" toward protecting patient choice.

Added Hall: "Somewhere between neutral and acceptance is where we're at on it now."

As for the proposal that set a time limit on the payment of uncontested health insurance claims, strong support by the House did not translate to strong support in the Senate, where HB 2098 bogged down in committee and no vote was taken. To Zeno, the plight once again showed the influence of the insurance industry.

"When the public pays their insurance, they expect the insurance company to pay the bills," Zeno says, adding that if an employee fails to pay a premium in time, their insurance is cut off.

When uncontested claims are not paid promptly, it creates a financial strain on rural hospitals, Zeno says. The plan only covered those "clean" claims, he says, giving more time for those disputed by the insurer.

Thirty days is "too restrictive," says Sen. Jay Bradford, D-Pine Bluff, founder of First Arkansas Insurance, who added that he would support some type of payment deadline.

"Certainly there is a fair time by which a claim should be paid," Bradford says, suggesting 45 days as a possibility.

Zeno is undeterred by the outcome of HB 2098 this time around. He feels the proposal brought awareness to a problem. Both Zeno and Bradford predict the issue will he revived in the next session.

Mental Health Parity

Bradford was a lead sponsor on the mental health parity proposal, SB 329. After clearing committee with a "do-pass" recommendation, it failed on third reading in the Senate and was assigned to an interim study committee for the next session.

Under the proposal, an amendment to Act 1020 for mental health parity in 1997, insurance plans that provide for mental health expenses should at least cover mental health expenses on a catastrophic basis. The proposal would not cover preventative care. If coverage for mental health expenses is not available, an insurer would be required to notify the employee, according to the bill.

"People deserve to have coverage for mental health problems," Bradford says.

Bradford cited instances where families were forced to get second mortgages or declared bankruptcy when their health coverage proved inadequate for covering mental health treatment. At least 24 other states have developed broader coverage for mental health, he says, adding that for Arkansas "it's coming."

Opponents of the measure say mental health parity would cause employers to suffer steep premium increases, possibly in the neighborhood of 20-25 percent, forcing some even to stop offering insurance for employees.

From an employer's perspective, Hall says strong opposition was prompted both by the cost and because the proposal mandated the coverage.

Bradford countered, saying the actuarial data he had seen projected a cost increase of 1-2 percent. He's confident the measure will eventually be approved.

"We have no problem if it's voluntary," Hall says, "but the mandated nature of that bothered us."

When it came to "victories" in the legislative session, Zeno points to the successful defeat of a proposal to repeal the soft-drink tax. The tax was former Gov. Jim Guy Tucker's solution for propping up the state's Medicaid program in December 1992.

Zeno says the tax raises about $45 million annually for the program, which is then matched on a 3-for-1 basis by federal funds. Repealing the tax would also jeopardize federal funds for the program, he says.

"It was not a tax the people are upset about," Zeno says, adding it was approved originally by voters.

Hall says the chamber was not opposed to the tax money funding the Medicaid program. However, Hall says, some in the hospitality business, hotels and the like, fearing possible effects on business, sought to repeal the tax, but also looked for a way to replace the money.

Hall and Bradford praised a couple of changes to workers' compensation provisions agreed to by management and labor groups. One of the proposals, SB 965, made some revisions to the procedure for the selection and changing of physicians in workers' comp cases. According to Hall, the agreements on the workers' comp bills were the result of months of negotiation.

Zeno went on to express "disappointment" about the failure of a handful of health policy bills. Proposals to lower the blood-alcohol limit for a driving while intoxicated charge, to require children to wear helmets while riding bicycles and to make not wearing a seat belt a primary offense all failed.

"All of those would have had an impact, saving lives and saving money," Zeno said.