Medicare program; payment to health maintenance organizations and competitive medical plans--HCFA. Proposed rule.
These proposed regulations would implement section 114 of the Tax Equity and Fiscal Responsibility Act of 1982. This provision of the law amended section 1876 of the Social Security Act, which authorizes Medicare reimbursement to eligible organizations on a prospective basis for those organizations that have a risk contract or on a reasonable cost basis for those that have a cost contract. The definition of an eligible organization includes both health maintenance organizations (HMOs) that meet the definition of a qualified HMO under the Public Health Service Act and competitive medical plans (CMPs). The purpose of this proposal is to set forth the requirements that an entity must meet in order to be (1) eligible to enter into a Medicare contract (either risk or reasonable cost) as an eligible organization and (2) reimbursed by Medicare on a capacitation basis (either prospectively or retrospectively) for items and services furnished to Medicare enrollees.
D014487:Centers for Medicare and Medicaid Services, U.S.; D006279:Health Maintenance Organizations / Q000191:economics*; D006278:Medicare / Q000331:legislation & jurisprudence*; D011445:Prospective Payment System / Q000331:legislation & jurisprudence*; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D014481:United States