Medicare program; enrollment provisions concerning health maintenance organizations and competitive medical plans--HCFA. Final rule with comment period.
For health maintenance organizations (HMOs) and competitive medical plans (CMPs), this final rule clarifies the financial responsibility of HMOs and CMPs for inpatient stays in hospitals paid under the prospective payment system when the patient begins or ends enrollment in the HMO or CMP during the hospital stay; eliminates the one full calendar month period between a request to disenroll and the effective date of disenrollment and requires a written explanation to disenrolling beneficiaries of exactly when their enrollment ends; and requires HMOs and CMPs to submit marketing materials for HCFA's review before their distribution to the public. This rule implements statutory provisions of sections 9211(a), (b) and (c) of Pub. L. 99-272, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
D014487:Centers for Medicare and Medicaid Services, U.S.; D006123:Group Practice / Q000331:legislation & jurisprudence*; D006125:Group Practice, Prepaid / Q000331:legislation & jurisprudence*; D006279:Health Maintenance Organizations / Q000331:legislation & jurisprudence*; D006760:Hospitalization; D006278:Medicare / Q000331:legislation & jurisprudence*; D011445:Prospective Payment System / Q000331:legislation & jurisprudence*; D014481:United States