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1998 SESSION


SENATE JOINT RESOLUTION NO. 108
Directing the Joint Commission on Health Care to study the participation of academic health centers in managed care provider networks.

Agreed to by the Senate, February 13, 1998
Agreed to by the House of Delegates, March 12, 1998

WHEREAS, the health insurance marketplace continues to change at a rapid pace in response to market demands for quality health care services at reasonable costs; and

WHEREAS, managed care has become the dominant form of health insurance coverage in the United States and Virginia as evidenced by the number of employers offering managed care plans to their employees and the transition of many government-sponsored programs, such as Medicare and Medicaid, to managed care plans; and

WHEREAS, there has been significant growth in recent years in the number of Virginians with health insurance coverage through health maintenance organizations; and

WHEREAS, market trends indicate that there will be continued growth in managed care plan enrollments; and

WHEREAS, academic health centers (AHCs) often are viewed primarily as tertiary care providers in managed care provider networks due to their prominence as referral centers, their specialty composition, research expertise, and the socioeconomic status of the patients located near the centers; and

WHEREAS, the selective contracting practices of many managed health care organizations have resulted in the Commonwealth's AHCs being included in a number of managed care provider networks only as tertiary care providers; and

WHEREAS, the state Medicaid program and the state employee health benefits program contract with managed care organizations to provide insurance coverage and health care services to a large number of Virginians; and

WHEREAS, there may be opportunities for the state Medicaid program and the state employee health benefits program to include provisions in their contracts with managed care organizations to enhance the ability of the AHCs to participate more fully in managed care provider networks; and

WHEREAS, there may be other strategies and actions that can be taken to improve the ability of the AHCs to participate more fully in managed care provider networks; now, therefore, be it

RESOLVED by the Senate, the House of Delegates concurring, That the Joint Commission on Health Care be directed to study the participation of academic health centers in managed care provider networks. The Commission shall, in cooperation with the academic health centers, the Department of Medical Assistance Services, the Department of Personnel and Training, and the Virginia Association of Health Maintenance Organizations, identify and analyze various opportunities to enhance the ability of the AHCs to participate more fully in managed care provider networks. The study shall include, but not be limited to, a cost-benefit analysis of the feasibility of (i) requiring managed care organizations that bid on the state employee health benefits program to include the AHCs as fully participating network providers in all products offered by the managed care organization and (ii) assigning Medicaid recipients enrolled in a mandatory managed care program, such as Medallion II, to a health plan that includes AHCs as fully participating network providers in those instances when the enrollee has not chosen another health plan.

The Joint Commission shall complete its work in time to submit its findings and recommendations to the Governor and the 1999 Session of the General Assembly as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents.