HSM420 State and Federal Regulation

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HSM420 State and Federal Regulation
Discuss state and federal regulation of MCOs. Do you think that there are enough…

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HSM420 State and Federal Regulation

HSM420 State and Federal Regulation

Course Discussions Week 7 All Students Posts – 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?

States have enacted a broad range of laws affecting managed health care, including requirements for the cooperate structures of payers, types of products sold in the individual and group insurance markets, information disclosures and other consumer protections, coverage mandates, contracting with health care providers, and solvency standards.
In consumer protections alone, there are several areas in which our states require full disclosures, fair billing practices, notice to privacy protections, appeals information, UR, and market review.

Have you ever read every page of the insurance packet you receive at a new job? Or the information we receive from our providers practices letting us know how they protect our privacy? Imagine not knowing all you know now; imagine if you didn’t have all that information at your fingertips. To actually read this stuff definitely makes us want to take a nap, but I’m glad there are people with our smarts and even smarter out there with the power to enforce these rules and regulations for our protection…