Biomedical subjects
Publications and source records attributed to Lillian MacEachern.
A number of states regulate the use of drug formularies by requiring MCOs and HMOs to disclose drugs listed on the plan formulary or to disclose procedures to obtain drugs that are not listed on the formulary.
Many questions exist surrounding the origins of the escalating cost of medical malpractice coverage. Insurers and health providers claim excessive litigation and overly generous jury awards have hardened the market. The American Trial Lawyers Association and consumer advocacy groups claim insurance premium rates have not tracked medical inflation or the payouts of jury awards over the last 30 years. State efforts have been hampered by the lack of conclusive data as to the cause . However, the potential impact is very clear, limited health care access as result of a loss in the health care workforce.
Today, almost half the states have laws obligating managed care organizations (MCOs) such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to contract with any willing health care provider. Although most provisions are limited to pharmacies or pharmacists, several states have adopted broad provisions applying to hospitals, physicians, chiropractors, pharmacists, podiatrists, therapists and nurses.
Consumer demand for a less restrictive referral system has urged legislators, as well as the managed care industry and those in the medical field, to seek the best solution to the problem. The point of service (POS) plan was an early attempt by managed care plans to provide more freedom for enrollees. But POS plans are not always available or cost effective. Several of the larger managed care organizations, in an effort to improve enrollee and provider satisfaction, have eliminated or streamlined their referral processes. The American Medical Association has recommended that primary care and other medical specialty organizations collaborate in developing guidelines for specialty referrals, urging health plans to allow direct access in network without financial penalty as long as the access conforms with the established guidelines. In the meantime, legislators have responded to constituents by enacting measures that mandate direct access for specific types of care or standing referrals for ongoing treatment.
Explore the source record for details and available documents.
The health care industry has historically used established formats for patient rights in order to maintain the integrity and quality of care in all settings of care provision. By establishing rights and responsibilities for patients, it increased patient involvement and created boundaries for acceptable practice for health care providers. As the provision of health care is evolving and including the health payor as never before, legislators are faced with the task of bridging the gap for consumers by creating protective measures that are referred to as a "Patient's Bill of Rights".
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A number of states regulate the use of drug formularies by requiring MCOs and HMOs to disclose drugs listed on the plan formulary or to disclose procedures to obtain drugs that are not listed on the formulary.
Explore the source record for details and available documents.
Today, almost half the states have laws obligating managed care organizations (MCOs) such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to contract with any willing health care provider. Although most provisions are limited to pharmacies or pharmacists, several states have adopted broad provisions applying to hospitals, physicians, chiropractors, pharmacists, podiatrists, therapists and nurses.
Explore the source record for details and available documents.
Forty-eight states prohibit managed care organizations (MCOs) from limiting a provider's ability to discuss potential treatment options with patients.
The health care industry has historically used established formats for patient rights in order to maintain the integrity and quality of care in all settings of care provision. By establishing rights and responsibilities for patients, it increased patient involvement and created boundaries for acceptable practice for health care providers. As the provision of health care is evolving and including the health payor as never before, legislators are faced with the task of bridging the gap for consumers by creating protective measures that are referred to as a "Patient's Bill of Rights".
State lawmakers across the country have begun to play an important role in ensuring that managed care plans establish and maintain grievance and appeals procedures that are responsive to the needs of their constituents.
When a health care provider leaves or is terminated by a managed care plan, how long can patients continue to receive covered treatment from that provider for a life-threatening condition, pregnancy, disability or other circumstance that requires continuous medical care? Lawmakers in 36 states have answered that question.
Consumer demand for a less restrictive referral system has urged legislators, as well as the managed care industry and those in the medical field, to seek the best solution to the problem. The point of service (POS) plan was an early attempt by managed care plans to provide more freedom for enrollees. But POS plans are not always available or cost effective. Several of the larger managed care organizations, in an effort to improve enrollee and provider satisfaction, have eliminated or streamlined their referral processes. The American Medical Association has recommended that primary care and other medical specialty organizations collaborate in developing guidelines for specialty referrals, urging health plans to allow direct access in network without financial penalty as long as the access conforms with the established guidelines. In the meantime, legislators have responded to constituents by enacting measures that mandate direct access for specific types of care or standing referrals for ongoing treatment.
Should managed care plans have the ability to limit an individual's "freedom of choice" when it comes to selecting a provider? As part of the anti-managed care movement of the early 1990s, 22 states enacted freedom of choice laws; the majority apply only to pharmacies.