Managed Care: State Regulation

Overview

As a result of intense lobbying by consumers and health care providers, managed care organizations are under close scrutiny. More and more frequently, states are taking assertive roles in governing managed care operations, including monitoring how they contract with providers and what types of benefits they provide to enrollees. In this volume, you'll learn how MCOs nationwide are being held accountable to a complex array of new laws —— and what you can expect and demand from ...
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Overview

As a result of intense lobbying by consumers and health care providers, managed care organizations are under close scrutiny. More and more frequently, states are taking assertive roles in governing managed care operations, including monitoring how they contract with providers and what types of benefits they provide to enrollees. In this volume, you'll learn how MCOs nationwide are being held accountable to a complex array of new laws —— and what you can expect and demand from MCOs according to new laws.

The book contains no figures.

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Product Details

  • ISBN-13: 9780834211209
  • Publisher: Jones & Bartlett Learning, LLC
  • Publication date: 3/9/1998
  • Series: Current Issue Series
  • Edition description: 1E
  • Edition number: 1
  • Pages: 184
  • Product dimensions: 9.00 (w) x 6.00 (h) x 0.39 (d)

Table of Contents

Preface
Introduction 1
Contracts with Providers 1
Contracts with Enrollees 6
Mandatory Health Service Coverage 13
MCO Operations 21
App. A NAIC Model Health Maintenance Organization Act Adoptions 28
App. B Table of Statutory Authorities 35
App. C Table of Selected Administrative Regulations Affecting HMOs 42
App. D Overview of Regulation in HMO Law States 46
App. E State HMO Act Mandated Benefits 53
App. F Quality Assurance: HMO Act States 62
App. G Reserve and Capital Requirements for Organizations Engaging in Prepayment Plans for Health Care 72
App. H Solvency Protection 89
App. I Financial Reporting Requirements 95
App. J Comprehensive Health Insurance and Health Care Cost Containment Model Act 101
Index 161
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