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Shown Here:
Public Law (12/29/1973)

(LATEST SUMMARY)

Health Maintenance Organization Act - Defines the term 'health maintenance organization' as a legal entity which provides basic and supplemental health services to its members and is organized and operated in a specified manner.

Sets forth the definitions of other terms used in this Act.

Authorizes the Secretary of Health, Education, and Welfare to: (1) make grants to and enter into contracts with public or nonprofit private entities for projects for surveys or other activities to determine the feasibility of developing and operating or expanding the operation of health maintenance organizations; (2) make grants to and enter into contracts with public or nonprofit private entities for planning projects for the establishment of health maintenance organizations or for the significant expansion of the membership of, or areas served by, health maintenance organizations; and (3) guarantee to non-Federal lenders payment of the principal of and the interest on loans made to private entities for planning projects for the establishment or expansion of health maintenance organization to serve medically underserved populations.

Provides that the Secretary may: (1) make loans to public or nonprofit private health maintenance organizations to assist them in meeting the amount by which their operating costs in the period of the first thirty-six months of their operation exceed their revenues in that period; (2) make loans to public or nonprofit private health maintenance organizations to assist them in meeting the amount by which their operating costs, exceed their revenues in that period which the Secretary determines are attributable to such expansion; and (3) guarantee to non-Federal lenders payment of the principal of and the interest on loans made to any private health maintenance organization if such health maintenance organization will serve a medically underserved population.

Provides that no grant, contract, loan, or loan guarantee may be made under this title unless an application therefor has been submitted to, and approved by, the Secretary. Prescribes the procedures for making such applications. Requires that each recipient of a grant, contract, loan, or loan guarantee under this Act shall keep such records as the Secretary shall prescribe.

States that for the purpose of making payments under various grants and contracts pursuant to this Act there are authorized to be appropriated $25,000,000 for fiscal year 1974, $55,000,000 for fiscal year 1975, and $85,000,000 for fiscal year 1976; and for fiscal year 1977, there is authorized to be appropriated $85,000,000.

Authorizes to be appropriated to the loan fund $75,000,000 in the aggregate for fiscal years 1974, and 1975.

Provides that each employer which is required to pay its employees the minimum wage under the Fair Labor Standards Act of 1938 and which employed an average number of employees of not less than twenty-five, shall include in any health benefits plan offered to its employees the option of membership in qualified health maintenance organizations which are engaged in the provision of basic and supplemental health services in the areas in which such employees reside.

Provides for the continued regulation of health maintenance organizations and for limitations on source funding for such organizations.

Directs the Comptroller General to evaluate the operations of at least fifty of the health maintenance organizations for which assistance was provided and to report to the Congress the results of the evaluation not later than ninety days after at least fifty of such health maintenance organizations have been in operation for at least thirty-six months.

Directs the Secretary to periodically review the programs of assistance authorized by this Act and make an annual report to the Congress of a summary of the activities under each program.

Requires the Secretary, through the Assistant Secretary for Health, to conduct evaluation programs respecting the effectiveness, administration, and enforcement of quality assurance programs.

Authorizes, for the purpose of carrying out such programs, to be appropriated $4,000,000 for fiscal year 1974; $8,000,000 for fiscal year 1975; $9,000,000 for fiscal year 1976; $9,000,000 for fiscal year 1977; and $10,000,000 for fiscal year 1978.

Directs the Secretary to undertake a study of health care quality assurance programs. Authorizes $10,000,000 for such purpose.

Provides for health services for Indians and domestic agricultural migratory and seasonal workers.