Legal Issues in Managed Care Contracting: Home Health Care in the 1990s

This article addresses the legal issues and considerations relevant to managed care contracting. An increasing demand for high-quality health care services and competitive rates in a managed care setting and the continuing trend toward home health care underscore the need for home health agencies to become competitive players in the managed care market. Federal and state laws affect structural options for establishing managed care networks, the ability to conduct case management, to take risk, and to agree on certain contract terms. Medicare law ultimately affects the ability of home health agencies to generate profits in the managed care setting. Home health agencies should ensure that they are not unreasonably put at risk for outcomes beyond their control.