APPENDIX B - POLICY CATEGORIES USED FOR MMC LAWS IN CHAPTER 3

Summary

Listed here are additional examples of policy instructions written into MMC legislation.

General Policy Language

Washington, 1993 – SB5304: The legislature establishes the rationale for the MMC program.

BASIC HEALTH PLAN – FINDINGS. (1) The legislature finds that:

1. (a) A significant percentage of the population of this state does not have reasonably available insurance or other coverage of the costs of necessary basic health care services;

2. (b) This lack of basic health care coverage is detrimental to the health of the individuals lacking coverage and to the public welfare, and results in substantial expenditures for emergency and remedial health care, often at the expense of health care providers, health care facilities, and all purchasers of health care, including the state; and

3. (c) The use of managed health care systems has significant potential to reduce the growth of health care costs incurred by the people of this state generally, and by low-income pregnant women, and at-risk children and adolescents who need greater access to managed health care.

Provider Responsibilities and Rights

Florida's SB321 (1989): Provides a good example of how legislatures provide specific reporting requirements for participating HMOs:

6.4. Any HMO participating in the state group insurance program shall, upon the request of the department, submit to the department standardized data for the purpose of comparison of the appropriateness, quality, and efficiency of care provided by the HMO. Such standardized data shall include: membership profiles; inpatient and outpatient utilization by age and sex, type of service, provider type, and facility; and emergency care experience. […]