Important laws and regulations in managed care organizations

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Important Laws and Regulations in Managed Care Organizations
Managed care is a system that provides for the management of certain factors crucial in healthcare. These are quality, cost and consumption. Regulation of this sector is done by both federal and state actors. Federal laws such as The Health Insurance Portability and Accountability Act of 1996(HIPAA) describe the minimum standards for health insurers that apply to MCO’s. Some of these include guaranteed availability that required that health status cannot be a reason for exclusion. State laws, on the other hand are more localized to the state level. These include that access to services and providers is ensured and timely (Fuchs, 1997). The question that will be answered is how these regulations come about and which approach works best. The systems used to arrive at the laws are simple. There are the federal statutes that are easily streamlined because they are reached by one central body. The issue is with state regulations that vary in every state. The process of creating these laws is: legislatures come up with motions, which are passed into law and then verified by comparing it to either, and federal or fellow state law (Fuchs, 1997).
This process is the way things are done. However, MCO’s have gone to court because the number and nature of these regulations create conflicts for the organizations. Streamlining may be an uphill task. At this time there is no one concrete system of streamlining regulation creation because every state is independent. Therefore, some MCOs are simply using the highest, strictest regulation and applying it across the board (Caroll, 2010). Another way, that streamlining is being done is by the courts by cases raised by MCOs against individual state regulations. The debate is ongoing.
References
Caroll, John.,...