Health Maintenance Organization

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

42 U.S.C. § 300

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.

Health Maintenance Organization: Open and Free Legal Research of US Law

Federal Primary Materials

The U.S. federal government system consists of executive, legislative, and judicial branches, each of which creates information that can be the subject of legal research about Health Maintenance Organization. This part provides references, in relation to Health Maintenance Organization, to the legislative process, the federal judiciary, and the primary sources of federal law (cases, statutes, and regulations).

Federal primary materials about Health Maintenance Organization by content types:

Laws and Regulations

US Constitution
Federal Statutory Codes and Legislation

Federal Case Law and Court Materials

U.S. Courts of Appeals
United States courts of appeals, inclouding bankruptcy courts and bankcruptcy appellate panels:

Federal Administrative Materials and Resources

Presidential Materials

Materials that emanate from the President’s lawmaking function include executive orders for officers in departments and agencies and proclamations for announcing ceremonial or commemorative policies. Presidential materials available include:

Executive Materials

Federal Legislative History Materials

Legislative history traces the legislative process of a particular bill (about Health Maintenance Organization and other subjects) for the main purpose of determining the legislators’ intent behind the enactment of a law to explain or clarify ambiguities in the language or the perceived meaning of that law (about Health Maintenance Organization or other topics), or locating the current status of a bill and monitoring its progress.

State Administrative Materials and Resources

State regulations are rules and procedures promulgated by state agencies (which may apply to Health Maintenance Organization and other topics); they are a binding source of law. In addition to promulgating regulations, state administrative boards and agencies often have judicial or quasi-judicial authority and may issue administrative decisions affecting Health Maintenance Organization. Finding these decisions can be challenging. In many cases, researchers about Health Maintenance Organization should check state agency web sites for their regulations, decisions, forms, and other information of interest.

State rules and regulations are found in codes of regulations and administrative codes (official compilation of all rules and regulations, organized by subject matter). Search here:

State opinions of the Attorney General (official written advisory opinions on issues of state law related to Health Maintenance Organization when formerly requested by a designated government officer):

Tools and Forms

Law in Other Regions

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