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HMO Restrictions Approved

February 26, 1997
By: Susana Vera
State Capital Bureau

JEFFERSON CITY - Doctors in areas of medical shortage would have stronger rights to be included in HMOs under a measure approved by the House Wednesday (Feb. 26).

The measure would require health maintenance organizations to accept any certified doctor who works in an area designated as having a shortage of medical professionals.

The bill's sponsor, Rep. Mary Bland, D-Kansas City, said the purpose of this legislation is to retain physicians who have cared for indigent patients in the past and now are being excluded from HMO plans.

"The HMO doesn't want the majority of these doctors in their panels because they think they are not competent", Bland said.

Under the proposal, a physician could seek state designation as an essential community provider if certain standards were met such a providing a minimum percentage of care for low-income and uninsured patients.

HMOs would be required to include their plans any essential community provider who sought inclusion.

Rep. John Loudon, R-Ballwin, warned that requirement could force HMOs to accept less than completely competent physicians.

"The intent of this bill may sound good, but I'm afraid it will attract non-competent doctors, since they are not required to have hospital certification," Loudon said.

But Bland argued that if a person is a licensed physician, has been practicing for several years and has no malpractice record, he or she is a qualified doctor.

House approval was the first vote this year by the legislature on a major HMO regulation bill.

Today, both House and Senate committees are scheduled to vote on the more sweeping package of HMO regulations recommended by a joint legisaltive committee this fall.