What are the legal implications of managed care?

Managed care is an umbrella term for various health care delivery systems that seek to control costs and manage utilization by emphasizing preventive care. In California, managed care is regulated by various state and federal laws, including the Knox-Keene Health Care Service Plan Act, the California Managed Risk Medical Insurance Board, and the California Health Benefit Exchange. Under managed care, health plans are required to provide the medically necessary treatments that are specified in the chosen plan, which is determined by the patient and their doctor. Health plans may also establish a network of health care providers, with the aim of containing costs and providing individuals with easier access to care. Other legal implications of managed care include the responsibility of health plans to ensure quality care, obey consumer protection laws, and provide accurate information. Health plans are legally required to provide certain benefits in accordance with state and federal regulations; if a plan does not meet these standards, it may be subject to fines or penalties. In addition, managed care plans have a responsibility to manage their financial risk. By utilizing tools such as utilization review and precertification, health plans can ensure that they do not incur costs from unnecessary care. Overall, managed care has a variety of legal implications, ranging from ensuring quality care to effectively managing financial risk. As a result, it is important for health plans to understand their legal obligations and adhere to state and federal regulations in order to provide the best care possible to their patients.

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What are the legal implications of managed care?

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