Medicaid program; freedom of choice: waivers of and exceptions to state plan requirements--Health Care Financing Administration. Interim final rule with comment period.
This regulation implements section 2175 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35). It revises in several ways the current requirements regarding a Medicaid beneficiary's right to choose among participating providers of covered items or services: (1) A State will not be found out of compliance with otherwise applicable requirements if it enters into certain arrangements to purchase laboratory services or medical devices through competitive bids, or if, under certain circumstances, it restricts for a reasonable period of time a specific beneficiary's choice of providers or the participation of a specific provider. (2) States may also request the Secretary to waive statutory requirements, as necessary, in order to: (a) implement a primary care case management system. (b) allow a locality to act as a central broker in aiding beneficiaries to select among competing health care plans, (c) share with beneficiaries, through provision of additional services, savings resulting from beneficiary use of more cost effective medical care, and (d) restrict beneficiaries to receive services (other than in emergency circumstances) only from efficient and cost-effective providers or practitioners. The purpose of these regulations is to provide States with increased flexibility in administering their Medicaid programs, in order that they may increase the efficiency and effectiveness of the delivery of health care services, and reduce their costs.
D003256:Community Participation / Q000331:legislation & jurisprudence*; D004465:Economic Competition / Q000331:legislation & jurisprudence*; D004467:Economics / Q000331:legislation & jurisprudence*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D014481:United States