Related Experiment Videos
Medicare and Medicaid programs; requirements for physician incentive plans in prepaid health care
Abstract:
This final rule amends the regulations established by a March 27, 1996, final rule with comment period. The regulations govern physician incentive plans operated by Federally-qualified health maintenance organizations and competitive medical plans contracting with the Medicare program, and certain health maintenance organizations and health insuring organizations contracting with the Medicaid program. As explained in the March 27 rule, the provisions of this final rule will also have an effect on certain entities subject to the physician referral rules in section 1877 of the Social Security Act.
Insights
This final rule updates physician incentive plan regulations for Medicare and Medicaid programs. It clarifies rules for Federally-qualified health maintenance organizations and competitive medical plans, impacting physician referrals.
Area of Science:
- Health Policy and Regulation
- Medical Economics
- Public Health Law
Background:
- Existing regulations for physician incentive plans were established by a March 27, 1996, final rule.
- These regulations apply to specific healthcare organizations contracting with Medicare and Medicaid.
Purpose of the Study:
- To amend and update the existing regulations governing physician incentive plans.
- To clarify the scope and applicability of these rules for various healthcare entities.
Main Methods:
- Final rule amendment process.
- Review and modification of existing regulatory text.
- Consideration of public comments (implied by 'final rule with comment period').
Main Results:
- Updated regulations for physician incentive plans are established.
- The amendments affect Federally-qualified health maintenance organizations (FQHCs) and competitive medical plans (CMPs) under Medicare.
- Certain health maintenance organizations (HMOs) and health insuring organizations (HIOs) under Medicaid are also impacted.
Conclusions:
- The updated rule provides revised governance for physician incentive plans in Medicare and Medicaid.
- These changes are intended to ensure compliance and potentially affect entities under section 1877 of the Social Security Act (physician referral rules).