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Managed care

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Listed below are direct links to Council on Medical Service (CMS) reports from June 1998 to the present related to managed care. The recommendations in these reports reflect the final actions of the AMA House of Delegates and are official AMA policy.

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Medical Care Outside the United States (PDF, 37KB)
CMS Report 1, A-08

The Role of Cash Payments in All Physician Practices (PDF, 46KB)
CMS Report 3, A-08

Value-Based Decision-Making in the Health Care System (PDF, 44KB)
CMS Report 7, A-08

Study of Cost Sharing Arrangements in Prescription Drugs (PDF, 31KB)
CMS Report 1, I-07

Fixed Reimbursement to Physicians for Laboratory Services (PDF, 36KB)
CMS Report 2, I-06

Update on Disease Management (PDF, 47KB)
CMS Report 4, A-06

Impact of the Health Maintenance Organization Act of 1973 (PDF, 142KB)
CMS Report 4, A-04

Limiting Financial Incentives to Withhold Appropriate Care (PDF, 84KB)
CMS Report 4, I-03

Hospital and Physician Payment for Uncompensated Care, Teaching, and Research (PDF, 94KB)
CMS Report 7, I-02

Medical Care "Carve-Outs" (Word, 36KB)
CMS Report 7, A-02

Continuity of Physicians and Pharmaceuticals in Managed Care Organizations (Word, 52KB)
CMS Report 8, A-02

TRICARE Contracting and Billing Issues (Word, 92KB)
CMS Report 1, I-01

Criteria for Level of Care Status (Word, 38KB)
CMS Report 5, I-01

Inappropriate Bundling of Medical Services by Third Party Payers (Word, 60KB)
CMS Report 6, I-01

Contact Capitation of Specialists (Word, 53KB)
CMS Report 1, A-01

Consistent Use of CPT Modifiers and Guidelines for Multiple or Bilateral Procedures (Word, 42KB)
CMS Report 2, A-01

Access to Mental Health Services (Word, 52KB)
CMS Report 9, A-01

Physicians' Experiences with Retrospective Denial of Payment and Down-Coding by Managed Care Plans (Word, 42KB)
CMS Report 5, I-00

Mental Health "Carve-Outs" (Word, 45KB)
CMS Report 6, I-00

Managed Care Organization Reimbursement Formulas (Word, 60KB)
CMS Report 6, A-00

Denial of Care and Appeal Mechanisms by Managed Care Companies (Word, 63KB)
CMS Report 8, A-00

Impact of Physician Assumption of Financial Risk (Word, 56KB)
CMS Report 4, I-99

Pharmacy Benefit Risk Sharing by Physicians (Word, 31KB)
CMS Report 12, I-99

Definition of "Medical Necessity" (Word, 30KB)
CMS Report 13, I-99

Reimbursement of Screening Bone Densitometry (Word, 81KB)
CMS Report 9, A-99

Relative Value Unit Based Reimbursement (Word, 49KB)
CMS Report 12, A-99

Benefits and Obligations of Tax-Exempt Status of Health Care Organizations (Word, 32KB)
CMS Report 15, A-99

Health Plan Coverage for Over-the-Counter Drugs (Word, 50KB)
CMS Report 1, I-98

Third Party Tie-In Agreements(Word, 43KB)
CMS Report 5, I-98

Delay in Payments Due to Disputes in Coordination of Benefits (Word, 71KB)
CMS Report 8, I-98

Physician Risk for Long-Term Care Placement Decisions (Word, 67KB)
CMS Report 9, I-98

Tax-Exempt Status of Health Care Organizations (Word, 48KB)
CMS Report 12, I-98

Definitions of "Screening" and "Medical Necessity" (Word, 50KB)
CMS Report 13, I-98

Free Choice of Surgical Pathology Consultants in Managed Care (Word, 42KB)
CMS Report 3, A-98

Equitable Payment by ERISA Plans (Word, 54KB)
CMS Report 6, A-98

Physician Recredentialing by Managed Care Plans (Word, 35KB)
CMS Report 8, A-98

National Provider Network of ERISA Plans (Word, 47KB)
CMS Report 13, A-98

Cost Savings Associated with Closed Panels Versus Open Panels (Word, 71KB)
CMS Report 14, A-98

Disease Management and Demand Management (PDF, 72KB)
CMS Report 3, I-97

Last updated: Jun 25, 2008
Content provided by: Council on Medical Service