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October 2, 1996

The Expanding Scope of State Legislation

Author Affiliations

From the Center for Organization and Delivery Studies, Agency for Health Care Policy and Research, Rockville, Md.

JAMA. 1996;276(13):1065-1070. doi:10.1001/jama.1996.03540130063031

EACH YEAR dozens of bills that govern the activities of managed care plans are introduced in state legislatures. Often, opponents refer to these as "anti-HMO," "anti—managed care," or "anticoordinated care," and supporters refer to them as "patient protection acts" or "fair managed care acts."

Some of these bills ensure enrollees direct access to certain types of medical specialists without the need for a referral from their primary physician, and others ban exclusive relationships between health plans and physician providers. In addition, more than a dozen bills were introduced in state legislatures in 1995 that set minimum lengths of hospital stays for deliveries.

This study traces the growth of 3 types of state laws that regulate managed care plans (direct-access laws, laws that prohibit exclusivity clauses, and laws that mandate minimum lengths of stay for deliveries). Arguments advocating and resisting these laws are examined along with information about their impact on