94-9485. Health Maintenance Organizations: Qualification Determinations and Compliance Actions During the Period October 1, 1993 Through December 31, 1993

[Federal Register Volume 59, Number 76 (Wednesday, April 20, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-9485]


[[Page Unknown]]

[Federal Register: April 20, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[OMC-017-N]

 

Health Maintenance Organizations: Qualification Determinations 
and Compliance Actions During the Period October 1, 1993 Through 
December 31, 1993

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice.

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SUMMARY: This notice sets forth the names, addresses, service areas or 
modified service areas, and dates of qualification or expansion of 
entities determined to be Federally qualified health maintenance 
organizations (FQHMOs) during the period October 1, 1993 through 
December 31, 1993. Additionally, this notice sets forth compliance 
actions taken by the Office of Prepaid Health Care Operations and 
Oversight for the period October 1, 1993 through December 31, 1993. 
This notice is being published in accordance with our regulations at 42 
CFR 417.144 and 417.163, which require publication in the Federal 
Register of certain determinations relating to FQHMOs.

FOR FURTHER INFORMATION CONTACT: Christine Boesz, [phone].

SUPPLEMENTARY INFORMATION:

A. Qualification Determinations

    As part of our evaluation and determination of whether an entity 
qualifies as a Federally qualified health maintenance organization 
(FQHMO), our regulations set forth at 42 CFR 417.144(e), promulgated 
under title XIII of the Public Health Service Act (the Act) (42 U.S.C. 
300e), require publication in the Federal Register of the names, 
addresses and descriptions of the service areas of new FQHMOs. We 
interpret this requirement as applying to revisions of service areas of 
currently approved FQHMOs, as well. Our last notice containing this 
information was published on January 7, 1994 (59 FR 1021).
    There are three categories of FQHMOs: operational, transitionally 
qualified, and preoperational. Definitions of these terms are set forth 
at Sec. 417.141.
    The Office of Prepaid Health Care Operations and Oversight has 
determined that the following entities are operational FQHMOs under 
section 1310(d) of the Act (42 U.S.C. 300e-9(d)) or have expanded their 
previously qualified service areas:

Expansions and Additions of Service Area Regional Components by 
Existing FQHMOs

    1. PacifiCare (Group Model; Requirements are set forth at section 
1310(b)(1) of the Act), 4000 Civic Center Dr., Suite 201, San Rafael, 
CA 94903-4133. PacifiCare's Federally qualified service area has been 
expanded to include Stanislas County.
    Date of qualification for service area expansion: November 18, 
1993.
    2. Good Health Plan of Oregon (GHP) (Individual Practice 
Association Model; Requirements are set forth at section 1302(5) and 
1310(b)(2)(a) of the Act), 1235 NE 47th Avenue, Suite 220, Portland 
Oregon 97213. GHP's approved Federally qualified expansion includes the 
following areas:
    a. In the State of Oregon--
    (1) The following counties in their entirety: Clackamas, Clatsop, 
Columbia, Multnomah, Washington, Yamhill.
    (2) The following zip codes in portions of Marion and Tillamook 
counties:

Marion
    97002, 97020, 97026, 97032, 97071, 97137, 97303, 97305, 97362, 
97373, 97375, 97381

Tillamook
    97108, 97118, 97130, 97131, 97136, 97147

    (b) In the State of Washington--
    (1) The following counties in their entirety: Clark, Skamania.
    (2) The following zip codes in portions of Cowlitz county: 98603, 
98609, 98616, 98625, 98674.
    Date of qualification for service area expansion: December 23, 
1993.

B. Compliance Actions

    The Office of Prepaid Health Care Operations and Oversight gives 
notice of the following compliance action affecting FQHMOs for the 
period October 1, 1993, through December 31, 1993:

Notice of Revocation:

    The Office of Prepaid Health Care Operations and Oversight 
considers voluntary relinquishment of participation to be a compliance 
action and sends a notice of revocation to the FQHMO. Notice was sent 
during the fourth quarter of calendar year 1993 to the following 
organization: 

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        Organization           Date Issued              Reason          
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Rush-Presbyterian, St.        12/23/93       Voluntary relinquishment   
 Luke's Health Plans Inc.,                                              
 Chicago, IL.                                                           
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C. Availability of Additional Information

    A cumulative list of FQHMOs and additional information may be 
obtained by writing to the following address:

Office of Prepaid Health Care Operations and Oversight, Health Care 
Financing Administration, Room 4406 Cohen Building, 330 
Independence Avenue, SW., Washington, DC 20201.

    The list also may be obtained by visiting that office between the 
hours of 8:30 a.m. and 4:30 p.m., Monday through Friday, except for 
Federal holidays. Interested persons may contact Margie Sharif for an 
appointment by telephoning [phone].

    Authority: Title XIII of the Public Health Service Act (42 
U.S.C. 300e).

    Dated: April 11, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 94-9485 Filed 4-19-94; 8:45 am]
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