State Freedom of Choice and Any Willing Provider Laws
AAMFT, along with patients’ rights groups and other allied organizations, has persuaded state legislatures to enact laws that allow clients to receive coverage from their insurance carriers if they receive covered mental health services from MFTs. There are two major types of laws that allow for MFT recognition by private payers: Freedom of Choice (Vendorship) and Any Willing Provider laws.
Freedom of Choice (FOC) laws require insurers and other health plans to reimburse providers listed in the law for providing services covered by the plan. FOC laws are also known as vendorship laws, direct access laws, any willing class of provider laws, and third-party reimbursement laws. Although varying in language and scope, these laws have the same result: allowing enrollees and beneficiaries to access the services of LMFTs. Although insurance companies may view these laws as “mandates,” these laws leave it up to their enrollees to determine whether to utilize the services of MFTs. In order for an MFT or an enrollee to receive reimbursement from a plan for services provided by the MFT, the service must be a benefit covered by the plan or a benefit recognized under the FOC law.
Currently, there are 28 states with FOC laws that include LMFTs: Alaska, California, Colorado, Connecticut, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, North Carolina, Oklahoma, Oregon, Rhode Island, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin. Although these laws are fairly comprehensive, some of the FOC laws exempt certain types of plans from the scope of the law.
The “Any Willing Provider” (AWP) laws require insurers and other health plans to enter into contracts with all qualified providers who are willing to accept a plan’s terms and rates. The major difference between a FOC law and an AWP law is that a FOC law normally does not prevent a payer from having a closed network of providers whereas an AWP law prevents a payer from keeping providers covered by the law out of its network. Three states, Idaho, Vermont, and Wyoming, have comprehensive AWP laws that require insurers to reimburse any willing MFT who provides services covered under an existing plan.
State
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Does state law require insurers to recognize MFTs?
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Type of MFT mandated provider law
|
Comments
|
Alaska
|
Yes
|
Vendorship
|
|
California
|
Yes
|
Vendorship
|
|
Colorado
|
Yes
|
Vendorship
|
|
Connecticut
|
Yes
|
Vendorship
|
|
Florida
|
Yes
|
Vendorship
|
|
Hawaii
|
Yes
|
Vendorship
|
Enacted in 2007.
|
Idaho
|
Yes
|
AWP
|
|
Illinois
|
Yes
|
Vendorship
|
Enacted in 2008.
|
Louisiana
|
Yes
|
Vendorship
|
Enacted in 2008.
|
Maryland
|
Yes
|
Vendorship
|
|
Maine
|
Yes
|
Vendorship
|
|
Michigan
|
Yes
|
both
|
Vendorship & AWP laws. AWP only applies to BCBS.
|
Minnesota
|
Yes
|
Vendorship
|
|
Mississippi
|
Yes
|
Vendorship
|
|
Missouri
|
Yes
|
Vendorship
|
Enacted in 2009.
|
North Carolina
|
Yes
|
Vendorship
|
|
Nebraska
|
Yes
|
Vendorship
|
|
New Hampshire
|
Yes
|
Vendorship
|
|
Nevada
|
Yes
|
Vendorship
|
|
Oklahoma
|
Yes
|
Vendorship
|
Enacted in 2008.
|
Oregon
|
Yes
|
Vendorship
|
Enacted in 2009.
|
Rhode Island
|
Yes
|
Vendorship
|
|
South Dakota
|
Yes
|
Vendorship
|
|
Tennessee
|
Yes
|
Vendorship
|
Enacted in 2010
|
Texas
|
Yes
|
Vendorship
|
|
Utah
|
Yes
|
both
|
Vendorship & AWP laws. AWP only applies to PPOs.
|
Virginia
|
Yes
|
both
|
Vendorship & AWP laws. AWP only applies to PPOs.
|
Vermont
|
Yes
|
AWP
|
|
Washington
|
Yes
|
Vendorship
|
|
Wisconsin
|
Yes
|
Vendorship
|
Enacted in 2009.
|
Wyoming
|
Yes
|
AWP
|
|
Notes:
1. The term “insurer” includes commercial insurance companies, nonprofit health service corporations (state Blue Cross Blue Shield plans), and managed care companies (HMOs, PPOs, etc).
2. There are two types of laws that mandate recognition of MFTs: Vendorship and Any Willing Provider (AWP) laws. Most of the states with MFT mandated provider laws have Vendorship laws, which require insurers and other health plans to reimburse or otherwise recognize certain classes of providers who provide services covered by the plans. AWP laws, on the other hand, require insurers to enter into contracts with all qualified providers who are willing to accept a plan’s terms and rates.
3. The laws in the states with broad MFT recognition generally apply to all state-licensed insurers. However, some of these laws might not apply to all types of insurers.
4. Three states have both Vendorship and AWP laws that apply to MFTs. In these states, the AWP laws only apply to one type of health care plan.
5. In the states with MFT Vendorship laws, the language of the laws can vary considerably. Some laws require that insurers directly reimburse MFT for covered services. Other laws require that insurers do not discriminate against MFTs as a class when selecting network providers. For additional information on these laws, look at the other information on the AAMFT.org website or contact AAMFT staff.