Managed care may find new harbors are safe, but stifling

Article Abstract:

The Department of Health and Human Services has created several new regulations to assist managed care organizations in complying with Medicare and Medicaid fraud and abuse laws. The new laws protect certain discounts to physicians offered by managed care plans. Financial incentives to encourage enrollees to use the plan are also protected. Finally, regulations have been altered regarding the waiver of coinsurance and deductibles for 'Medicare Select' insurers. Medicare Select provides Medicare supplemental insurance with fewer benefits when a non-preferred provider is used.

United States. Department of Health and Human Services

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Managed care for Medicaid: programs in N.Y., Md. aim for better physician pay, lower costs

Article Abstract:

New York State plans to move half its 2.1 million Medicaid patients into managed care by 1996. New York physicians' reimbursements will increase, but many doctors hesitate to join the program. In Maryland, on the other hand, most of 400,000 Medicaid recipients are enrolled in a primary case management program called Maryland Access to Care, which links patients with local physicians. Both programs aim to provide community-based care instead of more expensive emergency room treatments.

Management, New York, Medicaid, Maryland, New York (State)

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Setting the trend

Article Abstract:

California's Los Angeles County is establishing managed care procedures to improve health care to the region's poor, uninsured and Medi-Cal recipients. While proponents claim the system improves preventive care and reduces inefficiency, opponents fear health firms will start eliminating sicker patients from plans when fee-for-service disappears.

Health Care, Health Care and Social Assistance, Regulation, Licensing, and Inspection of Miscellaneous Commercial Sectors, Health Regulation, Medical care, Los Angeles County, California, Medical law

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