Public Law 93-222 created authority for the federal government to assist HMO development by providing grants, loans, and loan guarantees to offset the initial operating deficits of new HMOs that meet federal standards (e.g., are federally qualified) and to require most employers to offer an HMO to their employees as an alternative to traditional health insurance.

Type of Medicare Advantage Plan that is available in some areas of the United States. Plans cover all Medicare Part A and Part B health care. Some HMOs cover extra benefits (e.g., extra days in the hospital). In most HMOs the patient can only go to doctors, specialists, or hospitals on the plan’s list except in an emergency.

State agency that administers, licenses, and regulates health maintenance organizations (HMOs). In most states, this agency is the state insurance department. Also called HMO regulatory agency .

Entity that assumes the risk of paying for medical treatments and acts as an insurer for enrolled members under a fee-for-service or capitation system (i.e., insurance company, self-insured employer, group health plan, or managed care plan).

Set of standard performance measurements developed in 1989, 1993, and 1995 by the National Committee for Quality Assurance. It helps consumers, corporations, employers, and public purchasers of health care compare and determine the quality and value of managed care plans. HEDIS standardizes how health plans examine and report data including: quality of access to care, patient satisfaction, preventive medicine, membership and utilization, finance, and descriptive data on health plan management.