Health Maintenance Organization Amendments of 1988

(Conference report filed in House, H. Rept. 100-1056)

Health Maintenance Organization Amendments of 1988 - Amends the Public Health Service Act to revise the definition of "health maintenance organization" (HMO) to include public and private entities meeting certain criteria. (Current law includes legal entities meeting such criteria.)

Allows HMOs, in certain circumstances, to require a reasonable deductible to be paid by a member.

Requires that at least 90 percent of an HMO's services of a physician which are provided as basic health services be provided through members of the HMO's staff, medical groups, individual practice associations, health professionals under contract with the HMO, or any combination of such sources. (Current law requires all of an HMO's services to be provided through such sources.) Requires, when employee benefit plans allow employees a choice between two types of HMOs (described in current law), that: (1) one type provide at least 90 percent of its basic health services through physicians associated with such sources; and (2) the other type provide not more than ten percent of its basic health services through physicians not associated with such sources.

Requires the Secretary of Health and Human Services to issue regulations stating the circumstances under which the Secretary will consider the resources of an organization which owns or controls an HMO when evaluating the fiscal soundness of the HMO. Provides for the period prior to the effective date of the regulations.

Repeals a provision relating to the membership on the policymaking body of a private HMO and the advisory board to the policymaking body of a public entity operating a public HMO.

Continues in effect (by repealing its termination date) a provision which restricts from being included in the definition of "basic health service" those health services directly associated with an organ transplant, unless such organ transplant was required to be included in basic health services on April 15, 1985.

Creates an optional method for fixing payment rates for individuals and families by groups which requires fixing the rates on the basis of the organization's revenue requirements for providing services to the group, subject to certain limitations. Requires an HMO which uses this option for fixing payment rates, on request, to disclose the method and data used in calculating the payment rates.

Revises provisions relating to employees' health benefit plans to make those provisions applicable to employees of States or political subdivisions as well as to employees of private employers. Requires, for health benefits plans which include contributions for services, that the employer or State make contributions under plans for services offered by HMOs in an amount which does not financially discriminate against an employee who enrolls in an HMO.

Declares that provisions concerning financial discrimination shall not be construed to supersede collective bargaining agreements in effect on the date of enactment of this Act.

Repeals, seven years after this Act's enactment, the requirement that employee health benefit plans include the option of membership in an HMO. Requires employers which do offer such option to abide by financial discrimination prohibitions.

Adds to current provisions relating to State laws and practices which prevent entities from operating as HMOs, a provision declaring inapplicable State provisions which would prohibit an entity from complying with the title of the Public Health Service Act relating to HMOs.

Prohibits the Secretary from issuing any regulations, policy statements, or interpretations concerning the performance of medically necessary abortion procedures inconsistent with regulations, policy statements, interpretations, or practices in effect on the date of enactment of this Act.