Biomaterial Database

New HCFA regulations clarify PSO requirements. 1998

T H Brock

Proskauer Rose LLP, Washington, DC, USA.

In March and April of 1998, HCFA promulgated regulations regarding various requirements for provider-sponsored organizations (PSOs). These regulations define what constitutes an affiliated provider to a PSO, identify what percentage of services must be provided directly to beneficiaries by PSO affiliated providers, define what constitutes provider ownership in a PSO, and set minimum capitalization and liquidity standards for PSOs.

UI	MeSH Term	Description	Entries
D008329	Managed Care Programs	Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.	Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D009935	Organizational Affiliation	Formal relationships established between otherwise independent organizations. These include affiliation agreements, interlocking boards, common controls, hospital medical school affiliations, etc.	Affiliation, Organizational,Affiliations, Organizational,Organizational Affiliations
D010067	Ownership	The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.	Property Rights,Property Right,Rights, Property
D002017	Budgets	Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.	Budgetary Control,Budget,Budgetary Controls,Control, Budgetary,Controls, Budgetary
D002202	Capital Financing	Institutional funding for facilities and for equipment which becomes a part of the assets of the institution.	Financing, Capital,Funding, Capital,Capital Financings,Capital Funding,Capital Fundings
D006278	Medicare	Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)	Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D014487	Centers for Medicare and Medicaid Services, U.S.	A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.	Centers for Medicare and Medicaid Services,United States Centers for Medicare and Medicaid Services,United States Health Care Financing Administration,Centers for Medicare and Medicaid Services (U.S.),HCFA,Health Care Financing Administration,Health Care Financing Administration (U.S.),Health Care Financing Administration, U.S.
D019058	Community Networks	Organizations and individuals cooperating together toward a common goal at the local or grassroots level.	Community Care Networks,Community Health Networks,Care Network, Community,Care Networks, Community,Community Care Network,Community Health Network,Community Network,Health Network, Community,Health Networks, Community,Network, Community,Network, Community Care,Network, Community Health,Networks, Community,Networks, Community Care,Networks, Community Health