Excerpts From The State Of Pennsylvania’s Governor’s Drug Policy Council Staff Inquiry Into Managed Care (September 17, 1991)

OPEN MINDS The Behavioral Health & Social Service Industry Analyst OPEN MINDS Extra! Group health insurance plans in Pennsylvania are required by law to offer treatment for chemical dependency. Critics charge that such laws are being ignored. The most vocal criticism is aimed at health maintenance organizations (HMOs) and the independent assessment organizations that HMOs employ to serve as gatekeepers. . . The Departments of Health and Insurance have also been criticized for failing to enforce the foregoing legislation.. HMOs typically pay the assessment organization a flat monthly fee for each subscriber, an arrangement commonly known as a capitated fee. Capitated fees . . .