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医疗保险和医疗补助计划；对基于风险的健康维护组织和竞争性医疗计划提供的服务进行护理质量审查的实体——医疗保健财务管理局。有意见征求期的最终规则。

Medicare and Medicaid programs; entities performing quality of care review of services provided by risk-basis health maintenance organizations and competitive medical plans--HCFA. Final rule with comment period.

出版信息

Fed Regist. 1987 Oct 7;52(194):37454-8.

PMID:10301903
Abstract

This final rule provides for review by Utilization and Quality Control Peer Review Organizations (PROs) of the quality of care furnished by risk-basis health maintenance organizations and competitive medical plans under 42 CFR Part 417, Subpart C. It also provides for this same review by non-PRO entities and identifies the requirements that these non-PRO entities must meet. This rule is necessary for the timely implementation of section 1154(a)(4) of the Social Security Act, as amended by section 9353(a)(2) of the Omnibus Budget Reconciliation Act of 1986 (Pub. L. 99-509).

摘要

本最终规则规定，由利用与质量控制同行评审组织（PROs）对依据《联邦法规汇编》第42编第417部分C子部分的基于风险的健康维护组织和竞争性医疗计划所提供的医疗服务质量进行评审。它还规定由非PRO实体进行同样的评审，并确定这些非PRO实体必须满足的要求。本规则对于及时实施经1986年《综合预算协调法》（公法99 - 509）第9353(a)(2)节修订的《社会保障法》第1154(a)(4)节而言是必要的。

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