Health Maintenance Organization Amendments of 1981

(Reported to House from the Committee on Energy and Commerce with amendment, H. Rept. 97-88)

Health Maintenance Organization Amendments of 1981 - Amends the Public Health Service Act to authorize appropriations for fiscal years 1982-1984 for health maintenance organization (HMO) planning and initial development. Limits eligibility to HMOs receiving specified funds during fiscal year 1981. Authorizes specified appropriations for fiscal years 1982-1984 for: (1) technical assistance and training (including the National Health Maintenance Organization Intern Program); and (2) the loan fund. Extends loan guarantees for planning and initial development through fiscal year 1984.

Revises HMO requirements to: (1) eliminate the prohibition on direct service contracts with private physicians; (2) permit nonmetropolitan HMOs to provide certain basic health services outside their service areas if such services are not otherwise available; and (3) eliminate open enrollment periods and certain policymaking body membership and advisory body requirements.

Eliminates certain mental health, alcohol, and drug abuse services from the definition of "basic health services". Requires an HMO to provide such services in its plan if so requested by the employer. Revises the definition of "supplemental health services".

Permits pay rates to be alternatively fixed for individuals or families by groups under the "community rating system" definition. Sets forth the actuarial factors to be considered.

Makes private HMOs, that are not nonprofit, eligible for initial operation cost loans and loan guarantees. Increases the aggregate and 12-month amount of such loans and guarantees and extends their availability through fiscal year 1986.

Repeals the provision prohibiting cumulative loan guarantees to a private HMO to exceed fund obligations in any fiscal year.

Revises current loan authority for ambulatory care facility construction and acquisition. Requires an HMO to have: (1) revenues which exceed its costs; and (2) independent loan sources if necessary.

Permits interest rates to be adjusted for HMO loans.

Requires an employer subject to this Act who includes certain commercial insurance or nonprofit carrier-owned HMOs in his employee health benefits plan to include an additional HMO (if one exists) which has at least 25 employees (of such employer) residing in its service area.

Eliminates loan and grant priorities for nonmetropolitan areas and medically underserved populations.

Modifies certain financial disclosure requirements. Repeals the provision requiring certain evaluation reports from the Comptroller General. Eliminates State certificate of need requirements for all HMOs providing institutional health services (currently required of HMOs with less than 50,000 members).