A health maintenance organization (HMO) that delivers health services through salaried physicians who are employed by the HMO exclusively to care for HMO enrollees. (Also see group-model HMO and network-model HMO.)
Prohibits physicians from making referrals for certain designated health services payable by Medicare to an entity in which the physician has a financial interest. It originally applied to clinical laboratory service only. Congress expanded the law in 1995 to include...
Running from October 2011 through September 2015, this program provided Medicaid matching incentives to increase home- and community-based services (HCBS). Participating states were required to make structural reforms to reduce institutional care as appropriate and...
A federal program that provides funding to states to provide Medicare beneficiaries and other consumers with free health insurance counseling and assistance.
State coverage laws requiring private insurers to cover specific services (such as well-baby care) or reimbursement for specific providers (such as psychologists). The Employee Retirement Income Security Act generally exempts self-insured companies from these...