National Medicare Competition Evaluation: The Structure of Quality Assurance Programs in HMOs (Health Maintenance Organizations) and CMPs (Competitive Medical Plans) Enrolling Medicare Beneficiaries - Final Analysis Report

摘要

The report provides background information and documentation of Health Care Financing Administration (HCFA) Quality assurance (QA) requirements, for both demonstration plans and Tax Equity and Fiscal Responsibility Act (TEFRA) HMOs. It describes how the demonstration plans responded to these requirements and highlights systematic differences in Quality assurance systems according to key plan characteristics (including age of the plan, model, Federal qualification status, and plan origins). The report also discusses changes in Quality assurance systems the plans made in response to increasing their elderly enrollment.