Question

Describe the key pieces of recent legislation that impact an MCO

Answer 1

1. Patient Protection and Affordable Care Act of 2010
This Act requires that Managed Care Organizations must provide higher level of care while reducing costs.

2. Clinical Laboratory Improvement Amendments of 1988 (CLIA)
This act requires all clinical laboratories, including those contracted for use by the Managed Care Organizations must have a certificate to operate; this would indicate that the laboratory meets the CLIA operational standards.

3. Insurance state regulations (for Managed Care Organizations that have commercial enrollees)
These laws requires that the Managed Care Organization must have the financially ability to operate as an insurance company.