MHA 6060 - Managed Care and Health Insurance

This course covers health insurance and managed care in the United States. It covers their history; health benefits coverage and types of health plans; the provider network and payment system; utilization management and accreditation; Medicare Advantage and Managed Medicaid; laws and regulations; and other topics. The course will cover the status of the Affordable Care Act (ACA). It also covers changes in provider payment models and medical management methodologies that can affect managed care plans and health insurance, to include updated and expanded coverage of payment systems and methodologies; discussion of the role of benefits design and medical necessity and its impact on benefits coverage; administrative costs and profits; Medicare Part D, the drug benefit, and the plans that offer it, as well as Medicare Advantage payment plans and Medicaid expansion under the Affordable Care Act.