MHA628 Week 6 Discussion.
docx
keyboard_arrow_up
School
University Of Arizona *
*We aren’t endorsed by this school
Course
628
Subject
Law
Date
Nov 24, 2024
Type
docx
Pages
3
Uploaded by ArizonaAssignmentHelp
Federal and State Regulations [WLOs: 1, 2] [CLOs: 3, 4, 5]
Prior to beginning work on this discussion forum, review the following:
Chapter 8: Laws and Regulations in Health Insurance and Managed Care
Cobra Is 35 (Almost); Requirements and Compliance Issues Still Vex Employers Links to an external site.
A New Look at Standing for ERISA Causes of Action in Defined-Benefit Plans
Download A New Look at Standing for ERISA Causes of Action in Defined-Benefit Plans
Here's Why the Affordable Care Act Is So Controversial | History
Links to an external site.
The federal government has increasingly overseen the insurance industry over the past few decades. Congress and federal regulatory agencies have played a considerable role in how managed care is provided. The laws are evolving and expanding. On the other hand, states have a broad range of control of managed care organizations. The main goals of the states are
to protect the interest of the consumer and regulate the structure of managed care organizations (MCOs).
Based on the first letter of your last name, read your assigned law and respond to the directives. Your initial post should be at least 350 words. Support your response with a minimum of two credible sources published in the last 5 years. Your sources must be formatted according to APA Style
Links to an external site.
as outlined in the Writing Center. The Scholarly, Peer-Reviewed, and Other Credible Sources
Links to an external site.
table offers additional guidance on appropriate source types.
If the first letter of your last name begins with
A through F, read the Employee Retirement Income Security Act (ERISA).
G through L, read the Consolidated Omnibus Budget Reconciliation Act (CORBA).
M through R, read the Health Insurance Portability and Accountability Act (HIPAA), particularly Title I, Title III, or Title IV.
S through Z, read the Patient Protection and Affordable Care Act (PPACA).
In your initial post,
Summarize your assigned federal law governing managed care and insurance market.
Describe its impacts on individuals, employers, and payers.
Identify two state laws regulating MCOs and health insurers. o
Note: Reference the section of State Oversight and Regulation in Chapter 8 of your textbook.
The Patient Protection and Affordable Care Act 2010 (PPACA)
is a significant piece of federal legislation; its main objectives are to increase healthcare access and change the US healthcare system, which will have a big impact on the insurance and managed care sectors. One of the most important aspects is the creation of Health Insurance Marketplaces, which offer information and standardized plans to help people and small companies make decisions.
In order to give consumers improved access to healthcare services, the PPACA sets a minimum medical loss ratio, guarantees assured issue and renewability, and requires the provision of basic health benefits (Treasure, Anderson, Hatcher, Makhoul, Johnson, Stefan & Griffith, 2023). Prescription medications, maternity care, hospital stays, and preventative care
are just a few of the services that are included in these benefits. The PPACA ensures that people have access to a minimum level of necessary healthcare services by making these benefits mandatory, which helps to create a healthy population.
The PPACA has a noteworthy effect on a number of stakeholders. Individuals now have greater access to health insurance, are less likely to have their coverage denied due to pre-
existing conditions, and can more easily access preventive services; this is a significant step toward ensuring that people with pre-existing conditions do not lose their essential insurance protection (Nikpay, Pungarcher & Frakt, 2020). Health insurance is a requirement for employers with 50 full-time workers or more, or else they risk fines that could affect compliance costs and possibly promote employee health (Kongstvedt, 2020). Payers, including insurance providers, have had to adjust to new laws requiring them to provide basic
health benefits and imposing limitations on prices depending on a person's health.
States are essential in regulating health insurers and managed care organizations (MCOs) in addition to federal laws. For example, in order to safeguard people's health information, states frequently pass health information privacy legislation that supplements federal laws such as HIPAA (NaseriBooriAbadi & Sheikhtaheri, 2020). To guarantee high-quality treatment and patient access within the state, state regulations may also govern contracts between MCOs and healthcare providers (Kongstvedt, 2020). These laws may cover matters such as reimbursement rates, network adequacy, and provider network access. The United States' managed care and insurance landscapes have seen significant transformations thanks to the Patient Protection and Affordable Care Act. The Affordable Care Act (ACA) attempts to establish a more just and effective healthcare system by boosting access to care, enacting consumer rights, and revolutionizing the insurance industry (Treasure et al., 2023). In order to
guarantee that every American has access to high-quality healthcare coverage and services, state rules are added to this federal statute to further improve and safeguard local healthcare delivery (Kongstvedt, 2020).
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help