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Essay / Research Paper Abstract
This 4 page paper discusses the agencies that regulate managed care programs. The writer notes that most regulations are at the state level. The writer also reports that some health care companies have had RICO charges brought against them and also briefly discusses the role courts play in this industry. Bibliography lists 5 sources.
Page Count:
4 pages (~225 words per page)
File: MM12_PGhmorg.rtf
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Unformatted sample text from the term paper:
Federal and State-level Medicare and Medicaid programs. The Office of Managed Care (OMC), which is a division within the Centers for Medicare and Medicaid Services (CMS), has regulatory
authority over all Federally-supported health maintenance organizations (HMOs) (Holmes, 2002). The OFC was initially called the Heath Care Financing Administration (HFCA) (Holmes, 2002). These programs would include Medicare and Medicaid.
The OMC is involved with the qualification of HMOs who are involved with Federally-supported health programs (Holmes, 2002). This office also assures the programs meet compliance requirements as outlined in
the Public Health Service Act (Holmes, 2002). This office is further involved with "qualified HMOs, "competitive medical plans" (CMPs), and other types of managed care plans; granting and administration of
81915 (b) waivers; and policy direction and technical assistance to CMS regional offices and State agencies on Medicaid managed care issues" (Holmes, 2002). In the mid- to late-1990s, most states
had already passed patient bills of rights (Willcox, 2000). Willcox (2000) reported that "jurisdiction over private health insurance complaints varies across states, with responsibility for indemnity health insurance, managed care
and quality complaints often split within or between state agencies" (Willcox, 2000). Although patient rights bills have been before the U.S. Congress several times, none have been enacted (Gatty, 2004).
In most states, regulations concerning private managed care companies and programs are put forth primarily by the states insurance regulatory agencies while the states health agencies involvement has been
diminishing (Willcox, 2000). Some states split the regulatory responsibility between agencies, depending on the specific type of insurance with many having a named managed care insurance agency (Willcox, 2000). The
type of assistance provided to consumers is also provided in different degrees and by different agencies from state to state (Willcox, 2000). There are ombudsman programs in some states that
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