Health Maintenance Organization Amendments of 1978

(Conference report filed in House, H. Rept. 95-1784)

Health Maintenance Organization Amendments - Extends the authorization of appropriations under the Public Health Service Act through fiscal year 1981 for: (1) grants and contracts for surveys of the feasibility of establishing, operating or expanding health maintenance organizations (HMO's); and (2) grants, contracts, loans and loan guarantees for planning and initial development costs related to the establishment of HMO's.

Increases the maximum dollar limit for initial development project grants, contracts, and loan guarantees for HMO's from $1,000,000 to $2,000,000, effective September 30, 1979. Increases from one to three years the time within which grants are available for the planning and initial operation of HMO's after a contract for an HMO has been made.

Increases the aggregate amount of principal of loans which may be made or guaranteed, or both, for the initial costs of operation of an HMO to $4,000,000 in total or $2,000,000 annually provided the Secretary of Health, Education, and Welfare makes a written determination of need.

Authorizes the Secretary to make loans to HMO's for projects for the acquisition or construction of ambulatory health care facilities and for the acquisition of equipment for facilities acquired or constructed with such loans and to guarantee to lenders: (1) their loans to nonprofit private HMO's for such projects; and (2) their loans to private HMO's for such projects which will serve medically underserved populations.

Authorizes a qualified HMO to receive a grant or loan guarantee for the expansion of its services or the significant expansion of its membership or the area served by it.

Requires the Secretary to establish a National Health Maintenance Organization Intern Program to provide training to individuals to become administrators of HMO's or to assume other managerial positions with HMO's.

Authorizes the Secretary to provide technical assistance through grants: (1) to entities for feasibility surveys to determine the feasibility of developing or expanding HMO's; (2) to entities for the initial development costs of HMO's; (3) to entities intending to become a qualified HMO; and (4) to HMO's.

Directs employers who are required to offer membership in a HMO to their employees to arrange, at the option of the employee, for payroll deductions from such employees' salary for membership in a qualified HMO.

Requires each HMO to annually file with the Secretary specified financial information. Requires the Secretary to annually file a report with Congress based on the information gathered from such financial disclosures.

Provides that any false statement or representation made knowingly and willingly in connection with any such financial statement shall be a felony punishable by a fine of $25,000 and/or five years imprisonment.

Requires public HMO's to have an advisory Board to the policymaking body operating the organization to which policymaking authority for the organization may be delegated.

Authorizes a HMO to seek reimbursement for the cost of services provided to a member entitled to benefits under a workmen's compensation law or an insurance policy.

Provides that a HMO need only make a good faith effort to provide health services in the event of a major disaster, war, riot, civil disturbance, or other similar event.

Provides that a HMO need not provide a basic health service which the Secretary determines is unusual or infrequently provided and not necessary for the protection of individual health.

Requires the Comptroller General to evaluate: (1) the adequacy and effectiveness of the policy and procedures of the Secretary for the management of the grant and loan programs established under Title XIII (HMO's) of the Public Health Service Act; and (2) the adequacy of the amounts of assistance available under such Title, and to report to Congress the results of the evaluations.

Amends Title XIX (Medicaid) of the Social Security Act to make it a crime for present or former State or local employees responsible for the expenditure of substantial amounts of Medicaid funds from committing any act in relation to the State Medicaid plan.

Amends Title XI (General Provisions and Professional Standards Review) of the Social Security Act to remove HMO's from the capital expenditures limitations of the Medicare, Medicaid, and Maternal and Child Health programs of such Act.