NEW YORK, NY - The National Conference of Insurance Legislators has committed to pursue model legislation to address controversial physician-payer networking issues. The proposed model with address, among other things, transparency in rental network arrangements.

Physicians and other healthcare providers contract with rental network preferred provider organizations (PPOs) to provide care at discounted rates, generally in exchange for increased patient volume, and third parties contract to access these networks and the discounts. Physicians have difficulties in determining reimbursement.
Physicians and industry representatives remain at odds over the scope of proper regulation. The main area of contention relates to "downstream" rentals--the number of times the information contained in the contract agreement can be sold, leased, assigned, or conveyed to other parties. The groups also disagree on language regarding applicability, definitions, as well as transparency, disclosure, and registration requirements.

Areas in which all the groups support include disclosure requirements on entities accessing network discounts, a ban on unauthorized parties, clear contract termination language, contractual obligations of third parties, and enforcement provisions.

During the 2007 and 2008 legislative sessions, Arkansas, Colorado, Connecticut, Florida, Idaho, Indiana, and Ohio passed legislation to regulate physician network arrangements--focusing exclusively on transparency and disclosure requirements.

NCOIL states that lawmakers will be confronting these issues in statehouses throughout the country in 2008, and it wants to provide guidance for the state legislatures.