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Full-Text Articles in Law
Increasing Consumer Power In The Grievance And Appeal Process For Medicare Hmo Enrollees, Kenneth J. Pippin
Increasing Consumer Power In The Grievance And Appeal Process For Medicare Hmo Enrollees, Kenneth J. Pippin
University of Michigan Journal of Law Reform
Federal law requires that Health Maintenance Organizations (HMOs) and Managed Care Organizations (MCOs) provide Medicare beneficiaries with specific grievance and appeal rights for challenging adverse decisions of these organizations. The Health Care Financing Administration (HCFA) is charged with enforcing these regulations. Currently, however, HCFA contracts with HMOs, allowing them to enroll Medicare beneficiaries despite the fact that many of the statutory and regulatory requirements are ignored by the Medicare HMOs. This is problematic because the elderly Medicare population may not be able to independently and adequately challenge the HMO's denial of care or reimbursement. Because HCFA has been reluctant and …
Managed Care- The First Chapter Comes To A Close, Sallyanne Payton
Managed Care- The First Chapter Comes To A Close, Sallyanne Payton
University of Michigan Journal of Law Reform
Introduction to the symposium, Managed Care: What's the Prognosis: Managing Care in the Next Century.
Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney
Clearing The Way For An Effective Federal-State Partnership In Health Reform, Eleanor D. Kinney
University of Michigan Journal of Law Reform
At century's end, states have assumed a very different role in the design, implementation, and operation of health service programs than they did twenty-five years ago. In the current volatile political atmosphere particularly at the federal level, states have taken up the mantle of healthcare reform in the final years of the 1990s. Yet there remain problems and difficulties with the current federal-state relationship in health reform. The critical question is whether states can successfully accomplish genuine reform given its politically charged, complex and costly nature. This question takes on particular significance for the most important reform-expanding coverage to the …
Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost
Managed Care Regulation: Can We Learn From Others? The Chilean Experience, Timothy Stoltzfus Jost
University of Michigan Journal of Law Reform
Because the United States relies on private insurance for financing health care to a much greater degree than do other nations, and because managed care as a form of private insurance is further developed in the United States than elsewhere, it is arguable that we have little to learn from other nations about managed care regulation. This Article tests this hypothesis with respect to Chile, a country where private insurance is widespread and managed care is emerging. It concludes that by studying the experience of other nations we might gain a larger perspective on the context of our concerns in …
The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall
The Competitive Impact Of Small Group Health Insurance Reform Laws, Mark A. Hall
University of Michigan Journal of Law Reform
This Article reports on findings from an extensive study of small group health insurance market reforms in seven states, enacted during the early 1990s. After summarizing the content and purpose of these reforms, this evaluation focuses on the impact these reforms have had on the nature and degree of market competition. The principal findings are: (1) small group health insurance markets are highly competitive, both in price and in product innovation and diversity; (2) although some insurers have left some or all of these states in part because of these reforms, an ample number of active competitors remain, even in …