As Per Writer 22

Question Description

Medicare Regulations

Medicare is a federally regulated program that mandates compliance toits standards through state and federal oversight. One of the primarypurposes of Medicare regulations is the protection of its recipients.Medicare Advantage is part of the Medicare Modernization Act, which waspassed in 2003. Search the Internet by using the following keywords:

• Medicare regulations
• Centers for Medicare
• Medicaid services

On the basis of your research, answer the following questions:

1. What are the purposes of Medicare regulations other than the one mentioned above?
2. How will the federal government enforce compliance in the MedicareAdvantage program? Which two other Medicare regulations do you think arethe most important for managed care organizations and why?
3. Do you think Medicare and Medicaid programs face challenges from theperspectives of providers, the government, and consumers (recipients ofMedicare or Medicaid)? Why or why not?
4. What are the different services provided by the Medicare andMedicaid programs? Do you feel there is a need to have two differentprograms? Why or why not?
5. Discuss the advantages and disadvantages of Medicare programs suchas Medicare Advantage and Medicare Part D. Do you think MedicareAdvantage programs ensure the survivability of Medicare? Why or why not?

Additionally, respond to the questions given below after reading thefollowing information in regard to control of managed care organizationsat the state level.

States have a broad range of control of managed health careorganizations. The main interests of the states are to protect theinterest of the consumer and regulate the structure of MCOs.

• Discuss the regulatory structure used to regulate MCOs and health insurers at the state level.
• Discuss how states came to be the primary regulators of insurance.
• Evaluate the most critical components of state oversight of HMO operations.
• Review the licensing requirements for MCOs in your state anddescribe the specific requirements to obtain a Certificate of Authority(COA). Compare to the requirements discussed in the course textbook.
• What are the protections available to consumers under the law inyour state? Compare these protections to what is discussed in thetextbook.
• In your opinion, are the state regulations designed for theconsumers, or are they designed for the MCOs? Use your course and textreadings to support your answer.

To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.