Medicare+Choice: what lies ahead?
Health plans have continued to exit the Medicare+Choice program in recent years, despite efforts of Congress and the Centers for Medicare and Medicaid Services (CMS) to reform the program. Congress and CMS therefore stand poised to make additional, substantial reforms to the program. CMS has proposed to consolidate its oversight of the program, extend the due date for Medicare+Choice plans to file their adjusted community rate proposals, revise risk-adjustment processes, streamline the marketing review process, enhance quality-improvement requirements, institute results based performance assessment audits, coordinate policy changes to coincide with contracting cycles, expand its fall advertising campaign for the program, provide better employer-based Medicare options for beneficiaries, and take steps to minimize beneficiary costs. Congressional leaders have proposed various legislative remedies to improve the program, including creation of an entirely new pricing structure for the program based on a competitive bidding process.
Layne
R Jeffrey
RJ
Fulbright & Jaworski LLP, Washington, D.C., USA. jlayne@fulbright.com
D000206:Actuarial Analysis; D000368:Aged; D002204:Capitation Fee; D014487:Centers for Medicare and Medicaid Services, U.S.; D003164:Competitive Bidding; D005375:Financial Audit; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006279:Health Maintenance Organizations / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D020398:Medicare Part C / Q000331:legislation & jurisprudence*; D020379:Risk Adjustment; D020414:Risk Sharing, Financial; D014481:United States