Federal laws--including the Ethics in Patient Referrals Act, the Health Maintenance Organization (HMO) Act of 1973, the Employee Retirement Income Security Act (ERISA), and the Federal Trade Commission Act--have impacted the ways that health plans conduct business. For instance, the Mosaic Health Plan must comply with the following federal laws in order to operate: Regulation 1: Mosaic must establish a mandated grievance resolution mechanism, including a method for members to address grievances with network providers. Regulation 2: Mosaic must not allow its providers to refer Medicare and Medicaid patients to entities in which they have a financial or ownership interest. From the answer choices below, select the response that correctly identifies the federal legislation on which Regulation 1 and Regulation 2 are based.

Question

Quizplus · Accepted Answer

Regulation 1 requiring a mandated grievance resolution mechanism is based on the HMO Act of 1973 which requires HMOs to establish a grievance process for members. Regulation 2 preventing providers from referring Medicare and Medicaid patients to entities in which they have a financial or ownership interest is based on the Ethics in Patient Referrals Act which prohibits physicians from referring patients to entities in which they have a financial interest for certain designated health services.

Federal Laws--Including the Ethics in Patient Referrals Act, the Health