HSM420 Discussions Week 7

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HSM420 Discussions Week 7
What are the most critical components of state regulation for managed care organizations? And which federal…

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HSM420 Discussions Week 7

HSM420 Discussions Week 7

Discussions Week 7 All Students Posts 68 Pages

State and Federal Regulation – 34 Pages

What are the most critical components of state regulation for managed care organizations? And which federal regulations also bring specific requirements for the operation of such entities? Discuss state and federal regulation of MCOs. Do you think that there are enough regulations for MCOs? …

What are the most critical components of state regulation?  What are a few of the mandates? What are some of the unique state regulations mandated in your state?  Why was this law developed? What are the healthcare regulations mandated in your state? What are some of the federal regulations that take precedence over state regulations?  Since MCOs cannot deny coverage for preexisting conditions, do they make the premiums of those with preexisting conditions higher?…

Patient Protection and Affordable Care Act – 34 Pages

Study the provisions of the Patient Protection and Affordable Care Act (PPACA) in your textbook. What will be the primary impacts of PPACA on managed care organizations. Consider both positive and negative impacts in your answer. Why was the PPACA developed?…

How many individuals are now insured due to PPACA?  What are some of the disadvantages to ACA?

Primary impacts by the PPACA is changes to physician reimbursement.  Currently, physicians work under a fee-for-service system, in which physicians will treat and bill for a patient’s care, generally through an insurance company and payment amounts are dictated by the Medicare Physician Fee Schedule.  The PPACA will change the current formula for physician payments by establishing a value based payment modifier that provides for differential payment based on the quality of care furnished…