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Receives financial assistance from the federal government but not a state government.

Is at a higher risk of operating at a loss than are most other hospitals.

Receives no payments directly from Medicaid for services rendered but rather receives a portion of the capitation payment that Medicaid makes to the health plans with which Preamble contracts.

Is eligible for capitation rates that are significantly higher than the FFS average for all covered Medicaid services.

Includes only primary care services

Covers such services as immunizations and laboratory tests

Can be used only if the provider's panel size is less than 50 providers

Covers such services as cardiology and orthopedics

Is a prospective payment system, whereas capitation is a retrospective payment system

Has a potential to induce providers to underutilize medical resources, whereas capitation does not have this potential disadvantage

Bases the amount of reimbursement on the actual medical services delivered, whereas reimbursement under capitation is independent of the actual volume and cost of services provided

Is most often used by health plans to reimburse healthcare facilities, whereas capitation is most often used by health plans to reimburse specialty care providers

Both Dr. Shah and Dr. Owen

Dr. Shah only

Dr. Owen only

Neither Dr. Shah nor Dr. Owen

The National Committee for Quality Assurance (NCQA) serves as the primary accrediting agency for most health maintenance organizations (HMOs).

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has developed standards that can be used for the accreditation of hospitals, but not for the accreditation of health plan provider networks or health plan plans.

States are required to adopt the model standards developed by the National Association of Insurance Commissioners (NAIC), an organization of state insurance regulators that develops standards to promote uniformity in insurance regulations.

Accreditation is an evaluative process in which a health plan undergoes an examination of its operating procedures to determine whether the procedures meet designated criteria as defined by the federal government or by the state governments.