Question

Examine the differences between state and federal regulations of managed care. Which regulations have more impact on managed care? Explain.

Requirements:

Submit your essay in a Word document. This assignment must be at least 500 words, with at least four references cited properly in APA format, and a title page (APA format). This assignment must be well- written with proper grammar, spelling, and punctuation. Follow the rubric.

Answer 1

WHO REGULATES MANAGED CARE ORHANIZATION DEPENDS ON WHO Sponsor it and bears the risk of paying for the insured services. Mainly it is the federal government which regulates managed care while state government is responsible for regulating insurance that offers a managed care policy. If a private sector employee sponsors a plan which is self insured and not from managed care organization, it would be solely regulated by federal government. If the private sector employee sponsors a plan which is associated with a managed care organization. Then its regulation depends on who bears the risk. If a mange care organization bears the risk then it will be state regulated and if risk is born by the employer then it will be regulated by federal government.

The Employee Retirement Income Security Act of 1974 (ERISA) and HIPAA Act operated under federal law and state regulation is left for only business of insurance. ERISA was enacted in 1974 to protect workers from the loss of benefits provided through the workplace. In 1996, HIPAA was motivated by concern that people faced lapses in coverage when they change or lose their jobs. Any state mandates do not apply to those covered by self-funded plans