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At least 73 records · Page 4Linked to original sources
PubMed2003

Medicare program; modifications to managed care rules. Final rule.

This final rule responds to comments that we received on a proposed rule that was published in the Federal Register on October 25, 2002. It implements certain provisions relating to the Medicare+Choice (M+C) program that were enacted in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection (BIPA) Act of 2000. It also addresses comments on, and makes revisions to, regulations that were discussed in the October 2002 proposed rule that were based on M+C program experience and feedback from M+C organizations.

Humans↗
PubMed2003

Medicare program; improvement to the Medicare+Choice appeal and grievance procedures. Final rule with comment period.

This final rule with comment period responds to comments on the January 24, 2001, proposed rule regarding improvements to the Medicare+Choice (M+C) appeal and grievance procedures. It establishes new notice and appeal procedures for enrollees when an M+C organization decides to terminate coverage of provider services. The January 24, 2001 proposed rule was published as a required element of an agreement entered into between the parties in Grijalva v. Shalala, civ. 93-711 (U.S.D.C. Az.), to settle a class action lawsuit. This rule also specifies a Medicare-participating hospital's responsibility for issuing discharge or termination notices under both the original Medicare and M+C programs, amends the Medicare provider agreement regulations with regard to beneficiary notification requirements, and amends M+C enrollee grievance procedures.

Humans↗
PubMed1999

Medicare program; changes to the Medicare+Choice program. Health Care Financing Administration (HCFA), HHS. Final rule.

The purpose of this final rule is to set forth limited changes to the Medicare+Choice regulations published in our June 26, 1998 interim final rule (63 FR 34968). Those regulations implemented section 4001 of the Balanced Budget Act of 1997 (BBA), which established the Medicare+Choice (M+C) program. This final rule addresses selected issues raised by commenters on the June 26, 1998 interim final rule where we have identified the need for changes or where we believe that clarifications are needed as soon as possible. Among these issues are provider participation procedures, beneficiary enrollment options, and several access-related issues, including initial care assessment requirements, notification requirements when specialists are terminated from an M+C plan, and several coordination of care requirements.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2002

Reversal of fortune: Medicare+Choice collides with market forces.

Private health plans' participation in Medicare was envisioned as a way to save taxpayers money and offer Medicare beneficiaries more choices and benefits. As enrollment grew, there were concerns about overpayments to some private health plans and wide geographic variation in plan payments. The Balanced Budget Act of 1997 (BBA) introduced significant payment changes and regulatory requirements for plans participating in the newly named Medicare+Choice (M+C) program. Since January 1999, scores of plans have reduced or ended their participation, disrupting coverage for more than two million seniors. While the BBA often is blamed for this turnabout, research by the Center for Studying Health System Change (HSC) indicates private market forces also played a key role in M+C's growing instability.

Budgets↗
PubMed2001

10 steps to successful billing under PPS.

Submission of RAPs and claims, and the proper reimbursement subject to various payment adjustments, has been an ongoing challenge for home health agencies since the implementation of home health prospective payment system (PPS). Home health agencies must constantly be aware of the effect of current PPS policies on reimbursement. Agencies should use all of the resources available to them to improve their ability to process RAPs and claims and be paid as quickly and accurately as possible.

Aged↗
PubMedDate not supplied

Medicare+Choice: an interim report card.

While the aim of Medicare+Choice (M+C) was to expand choice, the choices available to Medicare beneficiaries have diminished since its inception: Existing plans have withdrawn from M+C, few new plans have entered the program from among the newly authorized plan types, greater choice has not developed in areas that lacked choice, and the inequities in benefits and offerings between higher- and lower-paid areas of the country have widened rather than narrowed. Operational constraints probably explain the most immediate declines in M+C enrollment, but Congress's ability to foster success for M+C will ultimately depend on the way in which historical tensions related to competing goals and ideologies for the Medicare program are resolved.

Budgets↗