Health Maintenance
Organizations, or HMOs, are public or private organizations existing to provide supplemental health insurance to its participants.
Legislation
HMOs are federally regulated under the Health Maintenance Organization Act of 1973, as amended. The Act was put into law under the administration of former President Richard M. Nixon.
Agency
Under the Act, HMOs are governed by the Secretary of Health, Education and Welfare. The bill provides the opportunity for the Secretary to establish HMOs under both the private for nonprofit and the public sectors.
Qualifications
In order for an entity to be considered an HMO, it must be able to prove itself as "an organized system for providing health care or otherwise assuring health care delivery in a geographic area," according to the federal code. Additionally, the HMO must offer approved health services and openly offer their services to a voluntary group of individuals.
Services
Services offered through HMOs must be provided through either a staff member of an HMO organization or an individual health professional contracted through an HMO organization.
Reporting
HMOs are required to report certain information to the Secretary on a yearly basis. Examples of information required include operational costs, service use, and the manner in which services are marketed and made available.
Tags: health care, Health Maintenance
