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Contents

Health Maintenance Organization Amendments

Act Details

Health Maintenance Organization Amendments was, as a bill, a proposal (now, a piece of legislation) introduced on 1975-07-29 in the House of Commons and Senate respectively of the 94 United States Congress by James Fred Hastings in relation with: Alcoholic beverages, Alcoholism, Comprehensive health care, Health, Health maintenance organizations, Labor and employment, Loans, Medical care, personnel, and facilities, Narcotic addicts, Narcotics, Public health.

Health Maintenance Organization Amendments became law (1) in the United States on 1976-10-08

It was referred to the following Committee(s): (2)

House Interstate and Foreign Commerce (HSIF)
Senate Labor and Public Welfare (SSHR)

Sponsor

James Fred Hastings, member of the US congress
James Fred Hastings, Republican, Representative from New York, district 39

The proposal had the following cosponsors:

James Thomas Broyhill, Republican, Senator, from North Carolina
Charles Joseph Carney, Democrat, Representative, from Ohio, district 19
James Florio, Representative, from New Jersey, district 1
Henry John Heinz, Republican, Senator, from Pennsylvania
Lunsford Richardson Preyer, Democrat, Representative, from North Carolina, district 6
Paul Grant Rogers, Democrat, Representative, from Florida, district 11
James Haas Scheuer, Democrat-Liberal, Representative, from New York, district 8
James Wadsworth Symington, Democrat, Representative, from Missouri, district 2

Act Overview

Number: 9019 (3)
Official Title as Introduced: A bill to amend title XIII of the Public Health Service Act to revise and extend the program for the establishment and expansion of health maintenance organizations (4)
Short Title: Health Maintenance Organization Amendments
Date First Introduced: 1975-07-29
Sponsor Name: James Wadsworth Symington
Assignment Process: See Committe Assignments (5)
Latest Major Activity/Action: Enacted
Date Enacted (signed, in general (6), by President): 1976-10-08
Type: hr (7)
Main Topic: Health
Related Bills: (8)
hres777-94, Reason: rule, Type: bill
hr9456-94, Reason: identical, Type: bill
s1926-94, Reason: related, Type: bill
Summary of Health Maintenance Organization Amendments: Govtrack. Authored by the Congressional Research Service (CRS) of the Library of Congress.
Primary Source: Congress Website

Text of the Health Maintenance Organization Amendments

(Conference report filed in House H. Rept. 94-1513) Health Maintenance Organization Amendments – =Title I: Amendments to Title XIII of the Public Health Service Act= – Expands the program of health maintenance organizations by: (1) including the services of professional personnel and allied health professions personnel for the effective and efficient delivery of the basic health services; (2) authorizing them to provide basic health services through medical groups referral services and medical treatment for abuse of or addiction to alcohol or drugs and supplemental health services; and (3) guaranteeing to non-Federal lenders payment of principal and interest on loans made to establish or expand health maintenance organizations or to serve medically underserved populations. Provides that in any fiscal year the amount disbursed to a health maintenance organization under this Act shall not exceed $1000000. Requires employers of not less than 25 individuals to offer as a part of any health benefits plan the option of membership in qualified health maintenance organizations which a are engaged in the provision of basic health services. Provides that the substantial responsibility of the members of the medical group of the HMO should be the delivery of medical services to the HMO enrollees. Requires members of the medical group to pool their income and distribute it according to a plan that is not related to the provision of specific health services. Provides that an enrollee's status in the HMO not be known by the health professional at the time of provision of services. Permits Individual Practice Associations (IPAs) to qualify as HMOs. Provides that HMOs which have been in existence for five years or have an enrollment of 50000 members and have not incurred a deficit in the most recent fiscal year shall have open enrollment periods of at least 30 days not less than once a year in which they accept persons in order of application regardless of existing illness medical condition or degree of disability. Exempts such HMOs from enrolling persons confined to institutions because of chronic illness permanent injury or other infirmity. Provides for a four-year waiver of the requirement for community rating of payments for health services and supplemental health services from HMOs. Permits nonprofit private HMOs to obtain Federal loan guarantees for planning initial development and initial operation. Gives priority in such guarantees to HMO applicants proposing to serve medically underserved populations. Increases from $50000 to $75000 the amount of a grant or contract for a feasibility survey and from $125000 to $200000 the amount for and single planning project relating to HMOs. Extends the number of years of Federal assistance for initial operation of HMOs from three to five years. Authorizes the Secretary of Health Education and Welfare in order to enforce compliance with assurances made by health maintenance organizations respecting the provision of basic and supplemental health services to bring a civil action in Federal court. States that employers required to afford such an option shall not include the Government of the United States the government of the District of Columbia or any territory or possession of the United States any agency or instrumentality (including the United States Postal Service and Postal Rate Commission) of any of the foregoing or church-related organizations. Requires the Civil Service Commission to contract with any health carrier which is a qualified health maintenance organization approved by the Secretary of Health Education and Welfare and which offers a health benefits plan that meets the statutory standards for health benefits plans. Makes specified appropriations to finance the activities of health maintenance organizations for fiscal years 1977 and 1978. =Title II: Amendments to the Social Security Act= – Makes the definition of an HMO and the requirements thereof under title XVIII (Medicare) of the Social Security Act the same as those under the Public Health Service Act. Authorizes the Assistant Secretary of Health of the Department of Health Education and Welfare to determine whether an organization is an HMO under the Social Security Act. Requires under such Act that such HMOs have at least half of their members under age 65. Requires an annual open enrollment in such HMOs for Medicare beneficiaries. Makes the requirements for an HMO under title XIX (Medicaid) of the Social Security Act the same as those under the Public Health Service Act. Prohibits payments to States for expenditures incurred by contracting with an entity which provides comprehensive services hospital care and one other service or any three services which has not been determined to be an HMO on other than an cost basis or which has received grants as a community health or migrant health center. Establishes a Health Services Policy Analysis Center for additional health services research. Authorizes appropriations through September 20 1977 for home health extension.

Act Notes

[Note 1] An Act (like Health Maintenance Organization Amendments) or a resolution cannot become a law in the United States until it has been approved (passed) in identical form by both the House of Representatives and the Senate, as well as signed by the President (but see (5)). If the two bodys of the Congress versions of an Act are not identical, one of the bodies might decide to take a further vote to adopt the bill (see more about the Congress process here). An Act may be pass in identical form with or without amendments and with or without conference. (see more about Enrollment).
[Note 2] Proposals are referred to committees for preliminary consideration, then debated, amended, and passed (or rejected) by the full House or Senate. To prevent endless shuttling of bills between the House and Senate, bills like Health Maintenance Organization Amendments are referred to joint committees made up of members of both houses.
[Note 3] For more information regarding this legislative proposal, go to THOMAS, select “Bill Number,” search on (Health Maintenance Organization Amendments)
[Note 4] A bill to amend title XIII of the Public Health Service Act to revise and extend the program for the establishment and expansion of health maintenance organizations. The current official title of a bill is always present, assigned at introduction (for example, in this case, on 1975-07-29) and can be revised any time. This type of titles are sentences.
[Note 5] The Act is referred to the appropriate committee by the Speaker of any of the two Houses. Bills are placed on the calendar of the committee to which they have been assigned. See Assignment Process.
[Note 6] Regarding exceptions to President´s approval, a bill that is not signed (returned unsigned) by the President can still become law if at lest two thirds of each of the two bodys of the Congress votes to pass it, which is an infrequent case. See also Presidential Veto.
[Note 7] Legislative Proposal types can be: hr, hres, hjres, hconres, s, sres, sjres, sconres. A bill originating in the Senate is designated by the letter “S”, and a bill originating from the House of Representatives begins with “H.R.”, followed, in both cases, by its individual number which it retains throughout all its parliamentary process.
[Note 8] For information regarding related bill/s to Health Maintenance Organization Amendments, go to THOMAS.

Analysis

No analysis (criticism, advocacy, etc.) about Health Maintenance Organization Amendments submitted yet.

Alcoholic beverages
Alcoholism
Comprehensive health care
Health
Health maintenance organizations
Labor and employment
Loans
Medical care, personnel, and facilities
Narcotic addicts
Narcotics
Public health

Health Maintenance Organization Amendments

Health Maintenance Organization Amendments