In a unanimous opinion issued April 2, 2003, Kentucky Ass'n of Health Plans, Inc. v. Miller, the U.S. Supreme Court has held that two state "any willing provider" (AWP) statutes are not federally preempted and may be enforced against HMOs that offer qualified ERISA employee benefit plans in Kentucky. HMOs argued to the Court that the statutes, which require HMOs to include in their provider networks any health care provider willing to meet the HMO's participation terms and conditions, are not "laws which regulate insurance" that are saved from preemption under ERISA because the laws also regulate doctors and their relationships with HMOs. Rejecting this argument, the Court established the two requirements a state law must satisfy to survive ERISA preemption: it must be "specifically directed toward entities engaged in insurance," and "must substantially affect the risk pooling arrangement between the insurer and the insured." The Court held that the Kentucky AWP statutes satisfy these requirements, even though they also affect noninsurers. The Court reaffirmed other recent decisions upholding state laws as applied to ERISA plans, including a 2002 case in which the Court upheld a Pennsylvania law requiring HMOs to provide independent review of "medically necessary" service determinations. Managed care industry executives are claiming that the decision will result in higher health insurance premiums and diminished quality of care.

This material is not intended to create, and does not create, an attorney-client relationship between you and Vinson & Elkins L.L.P., and you should not act or rely on any of this information. As legal advice must be tailored to the specific circumstances of each case, nothing provided herein should be used as a substitute for advice of competent counsel. These materials do not constitute legal advice, do not necessarily reflect the opinions of Vinson & Elkins L.L.P. or any of its attorneys or clients, and are not guaranteed to be correct, complete, or up-to-date. Vinson & Elkins L.L.P. assumes no liability for the use or interpretation of information contained herein. This publication is provided "AS IS" WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT. Unless otherwise indicated, V&E attorneys listed are: not Certified by the Texas Board of Legal Specialization. None of the attorneys listed on this website is certified as an "expert" or "specialist" pursuant to any authority governing the practice of law in New York.

Vinson & Elkins is a registered limited liability partnership. Principal office-Houston.