Managed Care and Public Policy
Evaluating the Impact of One Federal and One State-Level Public Health Policy
The CMS 2016 Final Rule sought to align CMS-managed care programs with other marketplace health insurance coverage programs (Federal Register & Centers for Medicare & Medicaid Services, 2016). The CMS 2016 Final Rule has improved the efficiency of how states purchase managed care for beneficiaries from the marketplace. The rule has also improved the quality of managed care services and improved the protection of beneficiary rights under managed care plans. The 2016 Final Rule influences public and Managed Care Organizations (MCOs) accountability and transparency in managed care (DeVito et al., 2020).
The Public Act, 97-268, was formulated to focus on health insurance providers and other HMOs to include costs related to diabetes laboratory and diagnostics tests in their coverage plans. The Act has influenced policies and regulations for MCOs at the federal level, impacting diabetes prevention and equal accessibility to care services.
Comparing and Contrasting How Each Policy Caused the Managed Care Market to Grow or Retract
Federal and state policies on managed care are designed to establish market controls on care organizations, quality, accountability, effectiveness, and protection for users and providers. The policies have improved the adoption of managed care services, leading to growth in the market. The managed care market is expected to experience a Compound Annual Growth Rate (CAGR) of 5.7% by 2026 (GlobeNewswire|ResearchandMarkets, 2022). However, Rogers et al. (2019), in reference to the Affordable Care Act (ACA), argued that as health insurance providers fight to limit enforcement of such Acts and related consumer protections, they contribute to setbacks in access to health care. In the long run, this may retract the market as consumers avoid private providers and health insurance at large.
References
DeVito, N. J., Bacon, S., & Goldacre, B. (2020). Compliance with legal requirement to report clinical trial results on ClinicalTrials.gov: a cohort study. The Lancet, 395(10221), 361–369. https://doi.org/10.1016/S0140-6736(19)33220-9
Federal Register & Centers for Medicare & Medicaid Services. (2016). Federal Register: Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability. https://www.federalregister.gov/documents/2016/05/06/2016-09581/medicaid-and-childrens-health-insurance-program-chip-programs-medicaid-managed-care-chip-delivered
GlobeNewswire| ResearchandMarkets. (2022). United States Managed Care Market Trends and Developments. https://www.globenewswire.com/en/news-release/2022/04/20/2425216/28124/en/United-States-Managed-Care-Market-Trends-and-Developments-2022-2026-Modernization-of-Medicaid-Adoption-of-Cloud-Technology-and-Automation-of-Healthcare-Delivery-Services.html
Rogers, M. A. M., Kim, C., Lee, J. M., Basu, T., & Tipirneni, R. (2019). Private Insurance Coverage for Diabetes Before and After Enactment of the Preexisting Condition Mandate of the Affordable Care Act, 2005-2016. American Journal of Public Health, 109(4), 562–564. https://doi.org/10.2105/AJPH.2018.304933
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Question 
Various types of managed care organizations have emerged due to forces imposed by the state and federal governments, such as the HMO Act of 1973. For the Week 1 discussion, address the following:
Managed Care and Public Policy
Evaluate the impact of one federal and one state-level public health policy.
Compare and contrast the ways each policy caused the managed care market to grow or retract.
To support your work, refer to the readings and relevant outside research. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Your initial posting should be addressed at 150-300 words. Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.
Respond to your peers throughout the unit. Justify your answers with examples, research, and reasoning. Follow-up posts need to be submitted by the end of the week.