Document: 538 U.S. 329 KENTUCKY ASSOCIATION OF HEALTH PLANS, INC., ET AL.v.MILLER, COMMISSIONER, DEPARTMENT INSURANCE. No. 00-1471. Supreme Court of United States. Argued January 14, 2003. Decided April 2, Petitioner health maintenance organizations (HMOs) maintain exclusive "provider networks" with selected doctors, hospitals, and other health-care providers. Kentucky has enacted two "Any Willing Provider" (AWP) statutes, which prohibit "[a] insurer [from] discriminat[ing] against any provider who is ... willing to meet the terms conditions for participation established by insurer," require a "health benefit plan that includes chiropractic benefits [to] [p]ermit licensed chiropractor agrees abide [and] serve as participating primary provider." Petitioners filed this suit respondent, Commissioner Kentucky's Department Insurance, asserting AWP laws are pre-empted Employee Retirement Income Security Act 1974 (ERISA), pre-empts all state "insofar they relate employee plan," 29 U. S. C. § 1144(a), but saves from pre-emption "law[s] regulat[e] insurance ...," 1144(b)(2)(A). The District concluded although both statutes "relate to" plans under each law "regulates insurance" therefore saved Sixth Circuit affirmed. Held: Pp. 334-342. (a) For these be insurance," must "specifically directed toward" industry; general application have some bearing on insurers do not qualify. E. g., Pilot Life Ins. Co. v. Dedeaux, 481 41, 50. However, industry will covered 1144(b)(2)(A), regulate insurance, insurers. Insurers regulated "with respect their practices." Rush Prudential HMO, Inc. Moran, 536 355, 366. P. 334. (b) argue directed" toward industry. disagrees. Neither its terms, imposes prohibitions or requirements providers, may still enter networks conduct business outside Commonwealth otherwise laws. transgressed only when benefits," excludes network able terms. 334-336. (c) Also unavailing petitioners' contention fall 1144(b)(2)(A)'s scope because an practice focus upon relationship between third-party rely Group & Health Royal Drug Co., 440 205, 210, held arrangements pharmacies were "the `business insurance'" 2(b) McCarran-Ferguson Act. ERISA's saving clause, however, concerned (as provision) how characterize undertaken private actors, in regard what "regulate." "regulate" imposing right engage insurance. To come within clause those also substantially affect risk pooling arrangement insured. pass test altering permissible bargains insureds manner similar we upheld Metropolitan Massachusetts, 471 724, UNUM America Ward, 526 358, Prudential, supra. 337-339. (d) Court's prior use, varying degrees, cases interpreting §§ 2(a) ERISA context misdirected attention, failed provide clear guidance lower federal courts, and, case demonstrates, added little relevant analysis. never factors essential component 1144(b)(2)(A) inquiry. Today makes clean break clause. 339-342. 227 F. 3d 352, SCALIA, J., delivered opinion unanimous Court. CERTIORARI TO THE UNITED STATES COURT APPEALS FOR SIXTH CIRCUIT Robert N. Eccles argued cause petitioners. With him brief Karen M. Wahle, Jonathan D. Hacker, Barbara Reid Hartung. Elizabeth A. Johnson respondent. her Julie Mix McPeak William J. Nold. James Feldman States amicus curiae urging affirmance. Acting Solicitor General Clement, Deputy Kneedler, Howard Radzely, Allen H. Feldman, Nathaniel I. Spiller, Gary K. Stearman.* JUSTICE SCALIA 1 provides shall discriminate located geographic coverage area insurer, including Medicaid program partnerships." Ky. Rev. Stat. Ann. 304.17A-270 (West 2001). Moreover, conditions, reimbursement rates, standards quality person plan." 304.17A-171(2). We granted certiorari decide whether (ERISA) either, both, statutes. 2 * include several Kentucky-based association HMOs. In order control cost delivery, HMOs contracted providers create networks." Providers such agree render services HMOs' subscribers at discounted rates comply contractual requirements. return, receive patient volume higher than achieved nonnetwork lack access subscribers. 3 impair ability limit number networks, thus use assurance high quid pro quo membership entails. believe frustrate efforts control, ultimately deny consumers cost-reducing 4 1997, petitioners Eastern Kentucky, ERISA, 88 832, amended, now hereafter U.S.C. banking, securities" pre-emption, App. Pet. Cert. 64a-84a. affirming Court, "regulat[e] Assn. Plans, Nichols, 363-372 (2000). Relying 358 (1999), first "as matter common sense," 3d, 364, `insurers' id., then considered, "checking points guide-posts" analysis, three used determine fits our Id., 364. These are: "first, effect transferring spreading policyholder's risk; second, integral part policy insured; third, limited entities industry." Union Labor Pireno, 458 119, 129 (1982). found satisfied. 368-371. Notwithstanding analysis factors, reiterated "basic test" whether, commonsense view, 372. Finding passed "common sense" points," Ibid. 5 certiorari, 956 (2002). II 6 ascertain 7 It well clause; 50 (1987); see 366 (2002); FMC Corp. Holliday, 498 52, 61 (1990). At same time, As explained practices," S., contend reasons. First, direc[t]" practice. find neither persuasive. 8 claim doctors seek form That say, equally prevent entering into contracts insurers, just creating place. think it follows specifically direct 9 See 2001) (imposing obligations insurer[s]" provider); 304.17A-171 plan[s] includ[e] benefits"). And capable 304.17A-171. 10 course true consequence laws, (such providers) unable certain agreements But could said about Prudential. Pennsylvania's prohibiting exercising subrogation rights insured's tort recovery, Corp., supra, 55, n. 1, prevented enforceable allowing subrogation. Illinois' requirement independent review "medically necessary," 372, likewise excluded joining HMO would withheld exchange premium. Yet effects noninsurers, significant though been, inconsistent Regulations "directed almost always disable doing, entities, regulations forbid; does suffice place regulation clause.1 B 11 because, unlike 724 (1985), UNUM, actual policies. Rather, — view constitute "insurance practice." 12 support contention, 210 (1979), Act.2 follow mandating insurer-provider relationships fails "regulate insurance." Suppose required attorneys participate hours continuing legal education (CLE) year. This statute "regulates" even sitting through CLE classes State conditioned requirements, product lawyers clients. operate industry: Those wish (any insurer") provider. insurance; HMO's beside point. 13 emphasize insured Otherwise, aimed companies deemed contrary interpretation A requiring pay janitors twice minimum wage prerequisite engaging fail well, since alter policies, concern Brief 29. disagree. policies "laws 1144(b)(2)(A); suffices By expanding whom services, mandated-benefit Life, notice-prejudice rule sustained UNUM,3 independent-review provisions approved No longer closed prohibition affects type offer. III 14 Our decisions construing relied, determining practices (emphasis added), looked factors: 129. 15 unsurprising, statutory language differs Rather concerning itself "[t]he 1012(a), was "enacted purpose regulating 1012(b) asks merely "law regulates securities." What more, developed characterized 126 ("The issue before us peer exempt antitrust scrutiny added)); Drug, Appeals correct concluding Pharmacy Agreements insurance' meaning Act" added)). 16 holdings factor yet raise more questions answer wide opportunities divergent outcomes. May satisfy clause? Just one? happens if satisfied, "securely satisfied" "clearly satisfied," Prudential? 374; 373. Further confusion arises question proper subject one applies factors. inquired Mississippi's bad faith risk, 50, insurer-insured relationship, 51, industry, ibid.4 contrast, focused inquiry law, rather itself. 373 ("It obvious enough `an insured'" 374 final factor, `practice industry' satisfied . ." added; citation omitted)). 17 initially buttress previously reached conclusion Massachusetts' 742-743. referred them mere "considerations [to be] weighed" falls 49. emphasized "`require[d]'" points" after "common-sense" understanding. 374. called "guide-posts," using "confirm conclusion" 18 make hold engaged 368; Second, above, satisfies 19 20 reasons, affirm judgment Circuit. 21 so ordered. Notes: Briefs ofamici reversal American Association Inc., et al. Daly Temchine, Stephanie W. Kanwit, Jan Amundson, Quentin Riegel; Community Partners Thomas Goldstein Amy Howe; Society Human Resource Management Mark Casciari, Deborah Davidson, Nelson. amici affirmance Texas John Cornyn, Attorney Texas, G. Baldwin, Jr., First Assistant General, Jeffrey Boyd, Parsley, David Mattax Christopher Livingston, Attorneys officials respective jurisdictions follows: Bill Lockyer, California, Gregory D'Auria, Associate Connecticut, Jane Brady, Delaware, Butterworth, Florida, Earl Anzai, Hawaii, Ryan, Illinois, Albert B. Chandler III, Joseph Curran, Maryland, Drew Edmondson, Oklahoma, Annina Mitchell, Utah, Darrell V. McGraw, West Virginia, Anabelle Rodríguez, Puerto Rico; College Legal Medicine Miles Zaremski, Birnbaum, Bruce Brightwell; Medical Rust Stanley Fickle; Council Governments Richard Ruda Steven Goldblatt. "self-insurer multiple employer welfare arrangement[s] ERISA." 304.17A-005(23). 304.17A-270's self-insured non-ERISA forfeits status "insurancecompanies" pre-emption; need ibid. sort separate plan. Any superfluous "deemer clause," 1144(b)(2)(B), "be company purposes purporting [or] ...." would, absence allowed plans. Under (The deemer presents no obstacle reaches "not ERISA.") Both apply HMOs, act instead administrative noninsuring laws' begin with, administering plans, bring activity argument foreclosed 372 (2002), where noted contained "some overbreadth [215 Ill. Comp. Stat., ch. 125,] 4-10 [(2000)] beyond orthodox HMOs," "there reason Congress meant minimal noninsurers remove entirely category preemption." Section provides: "(a) every therein, taxation business. "(b) construed invalidate, impair, supersede fee tax business, unless relates insurance: Provided, June 30, 1948, July 1890, known Sherman Act, October 15, 1914, Clayton September 26, Federal Trade Commission applicable extent law." 59 34, 1012 added). While Ninth inCisneros America, 134 939, 945-946 (1998), aff'd part, rev'd remanded spread factor," requires actually risk. 337-338. governs cover claims submitted late, dictates assumed. certainly qualifies substantial approach rendered third repetition "common-sense view."UNUM 375; (1987).

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