Health Maintenance Organization in the United States
Legal Materials
The HMO/PPO Directory provides basic information on over 1,000 U.S. HMOs and Preferred Provider Organizations (PPOs). The Directory is available in print and online from Grey House Publishing.
Healthcare Integrity Data Bank: The U.S. Department of Health and Human Services maintains the “Healthcare Integrity and Protection Data Bank” (HIPDB) as part of “a national health care fraud and abuse data collection program for reporting and disclosing certain final adverse actions taken against health care providers, suppliers, or practitioners.” If you can get access to the HIPDB, you can see if an HMO has been successfully sued or disciplined for financial improprieties.
Information about these Data Banks is posted at www.npdb-hipdb.com/. However, access to the Data Bank is generally limited to government agencies, insurers and health care providers, suppliers and practitioners. If you need this sort of information, see if you can get it through one of those “eligible entities.”
Health Maintenance Organization Act of 1973
42 U.S.C. § 300 : US Code – Section 300: Project grants and contracts for family planning services
This description of the Health Maintenance Organization Act of 1973 tracks the language of the U.S. Code, except that, sometimes, we use plain English and that we may refer to the “Act” (meaning Health Maintenance Organization Act of 1973) rather than to the “subchapter” or the “title” of the United States Code.
U.S. Code Citation
U.S. Code Section and Head
- United States Code – Section 300
- Head of the Section:Project grants and contracts for family planning services
Text of the Section
(a) Authority of Secretary The Secretary is authorized to make grants to and enter into contracts with public or nonprofit private entities to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services, and services for adolescents). To the extent practical, entities which receive grants or contracts under this subsection shall encourage familiy participation in projects assisted under this subsection.
(b) Factors determining awards; establishment and preservation of rights of local and regional entities In making grants and contracts under this section the Secretary shall take into account the number of patients to be served, the extent to which family planning services are needed locally, the relative need of the applicant, and its capacity to make rapid and effective use of such assistance. Local and regional entities shall be assured the right to apply for direct grants and contracts under this section, and the Secretary shall by regulation fully provide for and protect such right.
(c) Reduction of grant amount.
The Secretary, at the request of a recipient of a grant under subsection (a) of this section, may reduce the amount of such grant by the fair market value of any supplies or equipment furnished the grant recipient by the Secretary. The amount by which any such grant is so reduced shall be available for payment by the Secretary of the costs incurred in furnishing the supplies or equipment on which the reduction of such grant is based. Such amount shall be deemed as part of the grant and shall be deemed to have been paid to the grant recipient.
(d) Authorization of appropriations For the purpose of making grants and contracts under this section, there are authorized to be appropriated $30,000,000 for the fiscal year ending June 30, 1971; $60,000,000 for the fiscal year ending June 30, 1972; $111,500,000 for the fiscal year ending June 30, 1973, $111,500,000 each for the fiscal years ending June 30, 1974, and June 30, 1975; $115,000,000 for fiscal year 1976; $115,000,000 for the fiscal year ending September 30, 1977; $136,400,000 for the fiscal year ending September 30, 1978; $200,000,000 for the fiscal year ending September 30, 1979; $230,000,000 for the fiscal year ending September 30, 1980; $264,500,000 for the fiscal year ending September 30, 1981; $126,510,000 for the fiscal year ending September 30, 1982; $139,200,000 for the fiscal year ending September 30, 1983; $150,830,000 for the fiscal year ending September 30, 1984; and $158,400,000 for the fiscal year ending September 30, 1985.
See Also
Doctors
Hospitals
Medical Materials
Mental Health Professionals
Health Maintenance Organization (HMO) in the International Business Landscape
Definition of Health Maintenance Organization (hmo) in the context of U.S. international business and public trade policy: A health organization that maintains clinics and hospitals and supplies physician and health care specialist care and medication based on a fixed annual fee per person (capitation financing).
Cause of Action Against a Health Maintenance Organization Under State Tort Law: an Overview
This section examines this type of action. This subject identifies the various elements of the Cause of Action Against a Health Maintenance Organization Under State Tort Law, offering a practical approach to the litigation issues of this cause of action. See also the entry about legal risks.
Health Maintenance Organization (HMO) in Health Care Law
A definition of Health Maintenance Organization (HMO) is available here: A health plan that provides coverage through a network of hospitals, physicians and other health care providers. HMOs typically require the selection of a primary care physician who is responsible for managing and coordinating all health care. Usually, referrals to specialist physicians are required, and the HMO pays only for care provided by an in-network provider.
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