Medicare News
| For Immediate Release: | Contact: |
| Thursday, February 11, 1999 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
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PARTIAL MEDICARE+CHOICE FINAL REGULATION PUBLISHED
Background: The Health Care Financing Administration today announced refinements to the Medicare+Choice program that improve beneficiary protections and access to information while making it easier for health plans to offer more options to beneficiaries. The refinements also include the creation of a federal advisory committee to help HFCA reach out to Medicare beneficiaries and better inform them about changes in the Medicare program, while learning from beneficiaries what information they want and need and the best ways to get it to them.
In August 1997, President Clinton and Congress enacted the Balanced Budget Act, and, on June 26, 1998, the interim final regulations for Medicare+Choice, the program that created new health care options and patient protections for Medicare beneficiaries, were implemented. Currently there are more than 340 Medicare+Choice plans -- primarily health maintenance organizations or HMOs -- providing health care services to more than 6 million Medicare beneficiaries who chose to enroll in managed care plans. They represent about 15 percent of the nearly 40 million Medicare beneficiaries across the United States.
After reviewing nearly 90 comments from interested individuals and organizations on the interim final rule, the Health Care Financing Administration identified the need for changes or clarifications in the interim final regulation. These include provider participation procedures, beneficiary enrollment options, coordination of care requirements and procedures to help health plans who serve Medicare beneficiaries.
Medicare+Choice Regulations
The Balanced Budget Act of 1997 created the Medicare+Choice program which provides Medicare beneficiaries with a wider range of health plan choices and information about these options. These include both the traditional managed care plans, such as HMOs, that have participated in Medicare on a capitated payment basis, as well as Medicare+Choice coordinated care plans (HMOs with or without point of service options, provider-sponsored organizations and preferred provider organizations); medical savings accounts and private fee-for-service plans.
On June 26, 1998, HCFA published an interim final rule that explained and implemented the provisions outlined in the BBA. This rule became effective on July 27, 1998. Since it is an "interim final rule," it does govern operation of Medicare+Choice, but is still subject to further revision in response to public comments. After a careful review of public comments, HCFA determined that several policy changes were needed to help in the implementation of the Medicare+Choice program. The adjustments include stronger beneficiary protections while making the administrative requirements on plans taking part in Medicare+Choice less burdensome. HCFA expects to issue a more extensive final rule later this year.
Beneficiary Provisions
All Medicare beneficiaries are in fee-for-service Medicare unless they choose to enroll in a managed care plan. The new rule expands some of the protections available to those beneficiaries whose managed care plans decide to withdraw from the Medicare program. The rule clarifies that these beneficiaries will have the opportunity for a special election period among other plans available in the community. This provision should facilitate continued choice and continuity of care.
In addition, the rule clarifies that plans will have to insure that beneficiaries are advised, in advance, of any last-minute changes so that they will have all the information they need to make informed choices during the November 1999 open enrollment period called for in the BBA.
In addition to the new rule, HCFA is establishing the Citizens Advisory Panel on Medicare Education to assist the agency in developing and disseminating unbiased information for Medicare beneficiaries to help them make informed decisions about how they receive health care. The Advisory Panel will also work with the National Medicare Education Program.
Reducing Administrative Burdens
The rule reduces a number of administrative responsibilities identified in the June 26 interim final rule.
These include requirements for health assessments of beneficiaries enrolled in a managed care plan. The new rule allows the requirement for an initial assessment within 90 days of enrollment to be considered met for commercial health plan enrollees who remain in the same managed care organization's Medicare+Choice plan when they become eligible for Medicare at age 65 or for enrollees who switch plans but remain under the care of the same primary care provider. The rule also gives managed care plans the ability to choose the form of the initial assessment.
