Extending due process protections in managed care credentialling to hospital privileges.
The Article analyzes two recent state court decisions granting due process rights to physicians deselected from managed care networks. The author applauds these decisions and argues that managed care organizations wishing to deselect a physician should be required to demonstrate (1) that they have a legitimate reason for doing so relating to quality of care, economic factors, or administrative considerations, and (2) that the deselection will not unduly affect the quality of healthcare available in the network. In addition, the author contends that these same due process requirements may be applied to the closely analogous area of hospital staff privileges in situations in which the privileges of hospital-based practitioners are tied to employment, or the grant or termination of exclusive contracts.
DePaul College of Law, LL.M., Saint Louis University School of Law, Missouri, USA.
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D002140:California; D002961:Civil Rights / Q000331:legislation & jurisprudence*; D003406:Credentialing / Q000331:legislation & jurisprudence*; D006801:Humans; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D008504:Medical Staff Privileges / Q000331:legislation & jurisprudence*; D009513:New Hampshire; D020403:Patient Freedom of Choice Laws; D014481:United States; D000078329:Workforce