[Federal Register Volume 59, Number 5 (Friday, January 7, 1994)]
[Notices]
[Pages 1020-1021]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-336]


[[Page Unknown]]

[Federal Register: January 7, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[OPHC-030-N]

 

Health Maintenance Organizations: Qualification Determinations 
and Compliance Actions During the Period July 1, 1993, through 
September 30, 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 July 1, 1993 through September 
30, 1993. Additionally, this notice sets forth compliance actions taken 
by the Office of Prepaid Health Care Operations and Oversight for the 
period July 1, 1993 through September 30, 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 (202) 619-0840.

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 October 5, 1993 (58 FR 51833).
    There are three categories of FQHMOs: operational, transitionally 
qualified, and preoperational. Definitions of these terms are set forth 
at 42 CFR 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. FHP, Inc. (Arizona) (Group Model, Requirements are set forth at 
section 1310(b)(1) of the Act), P.O. Box 52078, Phoenix, Arizona 85072-
2078. FHP's Federally qualified service area has been expanded to 
include the following counties: Maricopa, Pima, Pinal.
    Date of qualification for service area expansion: July 27, 1993.
    2. National Med, Inc. (NM) (Group Model; Requirements are set forth 
at section 1310(b)(1) of the Act), 1005 West Orangebury, suite B, 
Modesto, CA 95350. NM's Federally qualified service area has been 
expanded to include--
    a. Stanislaus County.
    b. The following zip codes in portions of Merced and San Joaquin 
counties:
Merced
San Joaquin

    Date of qualification for service area expansion: August 27, 1993.
    3. 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--
    a. The following counties: Alameda, Contra Costa, Sacramento, San 
Francisco.
    b. The following zip codes in Santa Clara County:

Santa Clara

95002 95008 95009 95013 95014 95015 95016 95020 95021 95026 95030 95031 
95032 95035 95036 95037 95038 95042 95044 95046 95050 95051 95052 95054 
95055 95056 95070 95071 95100 95101 95102 95103 95106 95108 95109 95110 
95111 95112 95113 95114 95115 95116 95117 95118 95119 95120 95121 95122 
95123 95124 95125 95126 95127 95128 95129 95130 95131 95132 95133 95134 
95135 95136 95137 95138 95139 95140 95141 95142 95148 95150 95151 95152 
95153 95154 95155 95156 95157 95158 95159 95160 95161 95164 95170 95171 
95172 95173
    Date of qualification for service area expansion: September 15, 
1993.

B. Compliance Actions

    The Office of Prepaid Health Care Operations and Oversight gives 
notice of the following compliance actions affecting FQHMOs for the 
period July 1, 1993, through September 30, 1993:
    1. Notice of Reestablished Compliance:

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                                                                Date    
                       Organization                        reestablished
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Kaiser Foundation Health Plan of Georgia, Inc., Atlanta,                
 GA......................................................       9/2/93  
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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 (202) 619-0845.


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

    Dated: December 29, 1993.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 94-336 Filed 1-6-94; 8:45 am]
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