HLT 308 GCU Risk Management & The Role of Managed Reflective Analysis The purpose of this assignment is to analyze the role of managed care organizations w

HLT 308 GCU Risk Management & The Role of Managed Reflective Analysis The purpose of this assignment is to analyze the role of managed care organizations within health care and risk management programs.

Reflect on and evaluate the role that the managed care organization (MCO) plays in today’s health care environment by developing a 250‐500-word response that addresses the following:

What is a health care organization’s administrative role in executing risk management policies and ensuring compliance with managed care organization (MCO) standards?
What value do the regulatory statutes of a typical MCO provide to a health care organization? Consider how strategies pertaining to policies such as conflict resolution and risk management affect patients as well as employees and employers.
What MCO responsibilities relevant to the Patient Protection and Affordable Care Act (ACA) and Center for Medicare and Medicaid Services (CMS) focus on fraud, waste, and abuse laws?

In addition to your textbook, you are required to support your analysis with a minimum of two peer‐reviewed references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Read “The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers by Combating Health Care Fraud,” from the CMS Newsroom (2016), located on the U.S. Centers for Medicare and Medicaid Services (CMS) website.

URL:

https://www.cms.gov/newsroom/fact-sheets/health-care-fraud-and-abuse-control-program-protects-consumers-and-taxpayers-combating-health-care

Read “Assessing Changes to Medicaid Managed Care Regulations: Facilitating Integration of Physical and Behavioral Health Care,” by Edwards (2017), located on The Commonwealth Fund website.

URL:

https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/assessing-changes-medicaid-managed-care-regulations-facilitating

View the presentation “EMTALA: A Shifting Landscape,” located on the American Bar Association (ABA) website.

URL:

https://www.americanbar.org/content/dam/aba/administrative/healthlaw/EMTALA_4_10_18.authcheckdam.pdf Course Code
HLT-308V
Class Code
HLT-308V-O501
Criteria
% Scaling
Percentage
100.0%
Administrative Role of a Health Care
Organization in Ensuring Compliance With
Managed Care Organization (MCO) Risk
Management Standards
25.0%
Value of MCO Regulatory Statutes to a Health
Care Organization
25.0%
MCO Responsibilities Relative to ACA and CMS
Focus on Fraud, Waste, and Abuse Laws
25.0%
Thesis Development and Purpose
5.0%
Argument Logic and Construction
5.0%
Mechanics of Writing (includes spelling,
punctuation, grammar, language use)
5.0%
Paper Format (use of appropriate style for the
major and assignment)
5.0%
Documentation of Sources (citations, footnotes,
references, bibliography, etc., as appropriate to
assignment and style)
5.0%
Total Weightage
100%
Assignment Title
Reflective Analysis: Risk Management and the Role of Managed Care
1: Unsatisfactory (0.00%)
An assessment of the administrative role of a health care
organization in ensuring compliance with MCO risk
management standards is not included.
An explanation of the value MCO regulatory statutes provide
to a health care organization is not included.
A description of the MCO responsibilities relative to the ACA
and CMS focus on fraud, waste, and abuse laws is not
included.
Paper lacks any discernible overall purpose or organizing
claim.
Statement of purpose is not justified by the conclusion. The
conclusion does not support the claim made. Argument is
incoherent and uses noncredible sources.
Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.
Template is not used appropriately, or documentation format
is rarely followed correctly.
Sources are not documented.
Total Points
70.0
2: Less Than Satisfactory (65.00%)
An assessment of the administrative role of a health care
organization in ensuring compliance with MCO risk
management standards is partially incorporated, but the
information provided is incomplete, inaccurate, or otherwise
deficient.
An explanation of the value MCO regulatory statutes provide
to a health care organization is partially incorporated, but the
information provided is incomplete, inaccurate, or otherwise
deficient.
A description of the MCO responsibilities relative to the ACA
and CMS focus on fraud, waste, and abuse laws is partially
incorporated, but the information provided is incomplete,
inaccurate, or otherwise deficient.
Thesis is insufficiently developed or vague. Purpose is not
clear.
Sufficient justification of claims is lacking. Argument lacks
consistent unity. There are obvious flaws in the logic. Some
sources have questionable credibility.
Frequent and repetitive mechanical errors distract the
reader. Inconsistencies in language choice (register) or word
choice are present. Sentence structure is correct but not
varied.
Appropriate template is used, but some elements are missing
or mistaken. A lack of control with formatting is apparent.
Documentation of sources is inconsistent or incorrect, as
appropriate to assignment and style, with numerous
formatting errors.
3: Satisfactory (75.00%)
An assessment of the administrative role of a health care
organization in ensuring compliance with MCO risk
management standards is present, but minimal detail or
support is provided for one or more components.
An explanation of the value MCO regulatory statutes provide
to a health care organization is present, but minimal detail or
support is provided for one or more components.
A description of the MCO responsibilities relative to the ACA
and CMS focus on fraud, waste, and abuse laws is present,
but minimal detail or support is provided for one or more
components.
Thesis is apparent and appropriate to purpose.
Argument is orderly but may have a few inconsistencies. The
argument presents minimal justification of claims. Argument
logically, but not thoroughly, supports the purpose. Sources
used are credible. Introduction and conclusion bracket the
thesis.
Some mechanical errors or typos are present, but they are
not overly distracting to the reader. Correct and varied
sentence structure and audience-appropriate language are
employed.
Appropriate template is used. Formatting is correct, although
some minor errors may be present.
Sources are documented, as appropriate to assignment and
style, although some formatting errors may be present.
4: Good (85.00%)
An assessment of the administrative role of a health care
organization in ensuring compliance with MCO risk
management standards is incorporated in full. The
submission encompasses essential details and provides
appropriate support.
An explanation of the value MCO regulatory statutes provide
to a health care organization is incorporated in full. The
submission encompasses essential details and provides
appropriate support.
A description of the MCO responsibilities relative to the ACA
and CMS focus on fraud, waste, and abuse laws is
incorporated in full. The submission encompasses essential
details and provides appropriate support.
Thesis is clear and forecasts the development of the paper.
Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.
Argument shows logical progression. Techniques of
argumentation are evident. There is a smooth progression of
claims from introduction to conclusion. Most sources are
authoritative.
Prose is largely free of mechanical errors, although a few may
be present. The writer uses a variety of effective sentence
structures and figures of speech.
Appropriate template is fully used. There are virtually no
errors in formatting style.
Sources are documented, as appropriate to assignment and
style, and format is mostly correct.
5: Excellent (100.00%)
An assessment of the administrative role of a health care
organization in ensuring compliance with MCO risk
management standards is comprehensive. The submission
further incorporates analysis of supporting evidence
insightfully and provides specific examples with relevance.
Level of detail is appropriate.
An explanation of the value MCO regulatory statutes provide
to a health care organization is present and comprehensive.
The submission further incorporates analysis of supporting
evidence insightfully and provides specific examples with
relevance. Level of detail is appropriate.
A description of the MCO responsibilities relative to the ACA
and CMS focus on fraud, waste, and abuse laws is
comprehensive. The submission further incorporates analysis
of supporting evidence insightfully and provides specific
examples with relevance. Level of detail is appropriate.
Thesis is comprehensive and contains the essence of the
paper. Thesis statement makes the purpose of the paper
clear.
Clear and convincing argument presents a persuasive claim in
a distinctive and compelling manner. All sources are
authoritative.
Writer is clearly in command of standard, written, academic
English.
Comments
All format elements are correct.
Sources are completely and correctly documented, as
appropriate to assignment and style, and format is free of
error.
Points Earned

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