Health Maintenance Organization Act of 1973

Health Maintenance Organization Act of 1973 From Wikipedia, the free encyclopedia Jump to navigationJump to search Health Maintenance Organization Act of 1973 Great Seal of the United States Long title An Act to amend the Public Health Service Act to provide assistance and encouragement for the establishment and expansion of health maintenance organizations, and for other purposes. Nicknames Commission on Quality Health Care Act Enacted by the 93rd United States Congress Effective December 29, 1973 Citations Public law 93-222 Statutes at Large 87 Stat. 914 Codification Acts amended Public Health Service Act of 1944 Titles amended 42 U.S.C.: Public Health and Social Welfare U.S.C. sections created 42 U.S.C. ch. 6A § 300e et seq. Legislative history Introduced in the Senate as S. 14 by Edward M. Kennedy (D-MA) on January 4, 1973 Committee consideration by Senate Labor and Public Welfare, House Interstate and Foreign Commerce Passed the Senate on May 15, 1973 (69-25) Passed the House on September 12, 1973 (369-40, in lieu of H.R. 7974) Reported by the joint conference committee on December 12, 1973; agreed to by the House on December 18, 1973 (agreed) and by the Senate on December 19, 1973 (83-1) Signed into law by President Richard M. Nixon on December 29, 1973 Major amendments Health Maintenance Organization Amendments of 1976, P.L. 94-460, 90 Stat. 1945[1] Health Maintenance Organization Amendments of 1978, P.L. 95-559, 92 Stat. 2131 Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, 95 Stat. 357 Health Maintenance Organization Amendments of 1988, P.L. 100-517, 102 Stat. 2578 Health Insurance Portability and Accountability Act (HIPAA), P.L. 104-191, 110 Stat. 1936 The Health Maintenance Organization Act of 1973 (Pub. L. 93-222 codified as 42 U.S.C. §300e) is a United States statute enacted on December 29, 1973. The Health Maintenance Organization Act, informally known as the federal HMO Act, is a federal law that provides for a trial federal program to promote and encourage the development of health maintenance organizations (HMOs). The federal HMO Act amended the Public Health Service Act, which Congress passed in 1944. The principal sponsor of the federal HMO Act was Sen. Edward M. Kennedy (MA). Contents 1 Principles 1.1 Benefits offered to Federally qualified HMOs 1.1.1 Qualifications of a Federally qualified HMO 2 Effects of the act 2.1 Problem areas 3 Amendments to the HMO Act of 1973 4 Further reading 5 Definitions 6 References Principles President Richard Nixon signed bill S.14 into law on December 29, 1973.[2] It included a mandated Dual Choice under Section 1310 of the Act.[3] Health Maintenance Organization (HMO) is a term first conceived of by Dr. Paul M. Ellwood, Jr.[4] The concept for the HMO Act began with discussions Ellwood and his Interstudy group members had with Nixon administration advisors[5] who were looking for a way to curb medical inflation.[6] Ellwood's work led to the eventual HMO Act of 1973.[7] It provided grants and loans to provide, start, or expand a Health Maintenance Organization (HMO); removed certain state restrictions for federally qualified HMOs; and required employers with 25 or more employees to offer federally certified HMO options IF they offered traditional health insurance to employees. It did not require employers to offer health insurance. The Act solidified the term HMO and gave HMOs greater access to the employer-based market. The Dual Choice provision expired in 1995. Benefits offered to Federally qualified HMOs Money for development Override of specific restrictive State laws Mandate offered to specific employers to offer an optional HMO plan as part of their employee benefits package Qualifications of a Federally qualified HMO To become federally qualified, the HMO must meet these requirements: Deliver a more comprehensive package of benefits;[8] Be made available to more broadly representative population; Be offered on a more equitable basis; More participation of consumers; All at the same or lower price than traditional forms of insurance coverage Effects of the act Federal Financial Assistance for developing HMOs—Assisted individual HMOs in obtaining endorsement (referred to as qualification) from the federal government[9] Marketing Support through Dual Choice Mandate—Required employers to offer coverage from at least one federally qualified HMO to all employees (dual choice). Problem areas Definition of "Medical Group"[10] Comprehensive Benefits and Limitations on Copays Open Enrollment and Community Rating Mandatory "Dual Choice" Delay in Implementation Amendments to the HMO Act of 1973 October 8, 1976: Health Maintenance Organization Amendments of 1976, P.L. 94-460, 90 Stat. 1945[11] November 1, 1978: Health Maintenance Organization Amendments of 1978, P.L. 95-559, 92 Stat. 2131 July 10, 1979: Joint resolution to amend the Public Health Services Act and related health laws to correct printing and other technical errors, P.L. 96-32, 93 Stat. 82 August 13, 1981: Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, 95 Stat. 357 October 24, 1988: Health Maintenance Organization Amendments of 1988, P.L. 100-517, 102 Stat. 2578 August 21, 1996: Health Insurance Portability and Accountability Act (HIPAA), P.L. 104-191, 110 Stat. 1936 Further reading Hall, Mark A.; Bobinski, Mary Anne; Orentlicher, David (February 20, 2008). The law of health care finance and regulation. New York: Aspen Publishers. p. 648. ISBN 978-0-7355-7299-7. OCLC 183928753. Leiyu Shi; Douglas A. Singh (2010). Essentials of the U.S. health care system (2nd ed.). Sudbury, Mass.: Jones and Bartlett Publishers. ISBN 978-0-7637-6380-0. J. L. Dorsey (January 1975). "The Health Maintenance Organization Act of 1973 (P.L. 93-222) and prepaid group practice plans". Medical Care. 13 (1): 1–9. doi:10.1097/00005650-197501000-00001. PMID 803289. Richard M. Nixon (December 29, 1973). "Statement on Signing the Health Maintenance Organization Act of 1973". Online by Gerhard Peters and John T. Woolley: The American Presidency Project. Definitions A Health Maintenance Organization (HMO) is a managed care plan that incorporates financing and delivery of an inclusive set of health care services to individuals enrolled in a network.[12]