Some states have enacted any willing provider laws. From the perspective of the health plan industry, one drawback of any willing provider laws is that they often result in a reduction of a plan's:
In the paragraph below, two statements each contain a pair of terms enclosed in parentheses.Determine which term correctly completes each statement. Then select the answer choice that contains the two terms you have chosen.In most states, a health plan can be held responsible for a provider's negligent malpractice. This legal concept is known as (vicarious liability / risk sharing). One step that health plans can take to reduce their exposure to malpractice lawsuits is to state in health plan-provider agreements, marketing collateral, and membership literature that the providers are (employees of the health plan / independent contractors).
The National Committee for Quality Assurance (NCQA) has integrated accreditation with Health Employer Data and Information Set (HEDIS) measures into a program called Accreditation '99. One statement that can correctly be made about these accreditation standards is that:
The National Association of Insurance Commissioners (NAIC) Managed Care Plan Network Adequacy Model Act defines specific adequacy and accessibility standards that health plans must meet. In addition, the Model Act requires health plans to:
The following statement(s) can correctly be made about the TRICARE managed healthcare program of the U.S. Department of Defense.1. Active-duty military personnel are automatically enrolled in TRICARE's HMO option (TRICARE Prime).2. Eligible family members and dependents can enroll in TRICARE Prime, the PPO plan (TRICARE Extra), or an indemnity plan (TRICARE Standard).
By definition, a measure of the extent to which a health plan member can obtain necessary medical services in a timely manner is known as:
