What did the Amendment to the HMO Act of 1973 allow federally qualified HMOs to do?

The amendment to the HMO Act of 1973 allowed federally qualified Health Maintenance Organizations (HMOs) to permit members to occasionally use non-HMO physicians and be partially reimbursed. This change was significant because it provided more flexibility for patients, who might sometimes need or prefer to see a specialist or a physician outside of their designated HMO network.

Before this amendment, HMOs typically had strict rules requiring members to use in-network providers for their services to be fully covered. By allowing limited use of non-HMO providers with partial reimbursement, the amendment aimed to enhance patient choice and access to care while still promoting the managed care aspects of HMOs.

This development marked a shift toward accommodating patient preferences and addressing some of the limitations that members faced when only restricted to in-network services, thus potentially increasing enrollment in HMOs by making them more appealing to consumers who valued the ability to see other healthcare providers.