Virginia: Mother of medical licensure independence

March 1, 2011

Given mounting pressures on Medicaid programs and new health insurance products, physicians must retain the flexibility to make their own business decisions and not be required to accept payments for their services that do not meet their costs.

Throughout organized medicine, there is discussion about the prospect of states requiring physicians to participate in third-party reimbursement programs as a condition of licensure.

Physicians have thus far successfully argued that such conditions must not be imposed. Reimbursement rates for many state-sponsored and new "low-cost" programs are so low, they argue, that payments do not cover the cost of providing care. Mandated participation would, therefore, force them to leave the state and/or adopt a cash-only policy.

With an eye toward the massive expansion of Medicaid planned for by the Affordable Care Act, it is more important than ever that medical licensure remain independent of participation in any health insurance program.

The Virginia General Assembly took action during its 2011 regular session to maintain licensure independence.

Delegate Chris Stolle, MD, introduced House Bill 2218 to specify that physicians could not be required to participate in third-party reimbursement programs as a condition of licensure. With support from the American Medical Association and Medical Society of Virginia (MSV), the bill sailed through the legislative process unanimously.

The MSV reported, "... with Medicaid enrollment expected to balloon by an additional 271,000 to 426,000 individuals in 2014, it is critical for Virginia to protect its Medicaid provider network through reasonable reimbursement and business practices. However, forcing physicians to accept lower-than-cost payment rates just to maintain their medical licenses isn’t the answer."

Given mounting pressures on Medicaid programs and new health insurance products, physicians must retain the flexibility to make their own business decisions and not be required to accept payments for their services that do not meet their costs. Physician members of the Virginia General Assembly are leading the way. Follow their path.

To learn more about legislative issues in your state, please visit AACU's Action Center today at www.aacuweb.org

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