|
ISSUES
HMOs and Managed Care
Center for Managed Care Established in Federal Government. On
September 3, 1998, the Federal Register announced the new
organizational statement regarding the establishment of the Center
for Managed Care (CMC) in the Health Resources and Services
Administration (HRSA). The Center was established in 1996. The new
statement declares that the Center will serve as the focal point
within HRSA for "leadership, coordination, and advancement of
managed care systems for safety net providers serving at risk,
vulnerable populations and for training programs for health
professionals." It will "provide leadership within HRSA for the
development of managed care policies and programs and in
coordinating policy development with other Departmental agencies."
It will also provide technical and other support to HRSA
components and other mission related agencies as they establish
managed care initiatives." The Center will provide training "in
all aspects of managed care including dissemination of best
practices" and develop "working relationships with the private
managed care industry to assure mutual areas of cooperation,
maximization of expertise and coordination" and assess "new and
existing managed care systems." Finally the CMC will be
responsible for "assur[ing] effective development of policies,
resources, program development and resolution of program barriers
and issues through working with "Foundations, private agencies and
other Federal, State, and local agencies."
Supreme Court: HMOs Declared Government Agents. On
August 12, 1998, a federal appeals court ruled that Medicare
patients are entitled to an immediate appeals process when HMOs
deny access to care. (5 days instead of 14 days) According to the
Minneapolis Star Tribune: "The appellate court said that in
running the Medicare HMO program, federal officials had not
fulfilled their duty to guarantee due process, as required by the
Fifth Amendment to the Constitution. Indeed, it said, Medicare
officials have not enforced their own rules and have improperly
renewed contracts with HMOs that violated the rules."
"[Judge Charles] Wiggins said Medicare beneficiaries were
entitled to due process because the HMO decisions amount to
'government action.' HMOs are private corporations, but when they
deny services to Medicare beneficiaries they act 'as a
governmental proxy,' he said" (August 14, 1998, Star
Tribune)
|
