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July 28, 2004 at 08:00 PM
The federal government may give Medicare managed care plans more authority to eject disruptive patients.[@@]
The Centers for Medicare and Medicaid Services included that relief for private insurers in one section of a mammoth package of proposed regulations that was released Monday. CMS, the arm of the U.S. Department of Health and Human Services, is proposing the regulations in an effort to implement the Medicare drug benefit and Medicare managed care plan provisions of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
In the past, officials encouraged private health maintenance organizations to participate in the Medicare program, but disputes over reimbursement rates and program rules eventually caused many private HMOs to abandon Medicare. The percentage of Medicare beneficiaries enrolled in Medicare HMOs dropped to 11% this year, from a high of 16% in 1999.
MPDIMA calls for the government to encourage participation by preferred provider organization plans and tempt private insurers back to Medicare with new reimbursement arrangements and changes in program rules.
In the past, private Medicare HMOs had a hard time knowing what to do about disruptive patients and patients who consistently failed to pay co-payments.
