Managed care at the crossroads: can managed care organizations survive government regulation?
Attorneys Brown and Hartung provide a comprehensive overview of the development and structural components of managed health care plans. The article discusses the state regulatory controls affecting managed care including Patient Protection Acts, mandated benefit provisions, any willing provider laws, and consumer access provisions. The article considers liability problems facing managed care organizations, in particular liabilities which arise from utilization and medical review discussions as well as gag clauses and financial incentive arrangements. The authors also review relevant federal regulatory initiatives.
Brown
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Greenebaum, Doll & McDonald P.L.L.C., Louisville, KY, USA.
Hartung
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BR
D019058:Community Networks; D005161:Facility Regulation and Control; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D007193:Independent Practice Associations; D007342:Insurance Benefits / Q000331:legislation & jurisprudence; D016365:Liability, Legal; D008329:Managed Care Programs / Q000331:legislation & jurisprudence* / Q000458:organization & administration / Q000592:standards; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D020403:Patient Freedom of Choice Laws; D011243:Preferred Provider Organizations; D013219:State Government; D014481:United States; D014600:Utilization Review / Q000331:legislation & jurisprudence