MEDICARE+CHOICE: Only 3 Applications From Providers
The Health Care Financing Administration has received only three applications "from groups seeking to form new types of health plans" for the new Medicare+Choice program, raising doubts about whether the host of choices touted by HCFA will be available by the time the program is slated to start early next year. Thus far, two provider-sponsored organizations and one PPO have submitted applications, which the Wall Street Journal calls a "lackluster start for the government's ambitious program to expand ... health care options" to Medicare recipients. HCFA Center for Health Plans and Providers Director Robert Berenson attributed the low number of submissions to plans needing "a year or longer to develop a business plan, ensure they meet government requirements on issues such as access and data collection for quality measurement, and get their provider networks up and running." Government guidelines for the programs, intended to encompass "private, fee-for-service insurance plans, PPOs and medical savings accounts [MSAs]," were only released in June. Consumer advocates, who "have expressed concern that [Medicare+Choice] would present seniors with a dizzying array of choices," aren't shedding any tears over the slow roll out of the program. Diane Archer, executive director of the Medicare Rights Center, said "[t]he slow start 'is not a bad thing for people on Medicare. They have a lot of choice today.'"
Shadow Of HMO Failures
The Journal reported that in addition to delays in completing applications for Medicare+Choice, "much of the hesitation among would-be new Medicare players comes from the recent turmoil among Medicare HMOs." Stephen Balcerzak of Managed Care Compliance Solutions Inc. said, "They're figuring if the HMO isn't doing well, maybe they need to think about what they are going to do." Nevertheless, HCFA has received "more than 50 applications ... from HMOs interested in serving the Medicare market," according to Dr. Berenson. Approximately 6 million people are currently served by Medicare HMOs (Jeffrey, 9/8).
User Fees On The Horizon?
According to Medicine & Health, a Senate Appropriations Committee report accompanying the Labor-HHS spending bill "keeps ... alive" a Clinton administration proposal to charge user fees to Medicare providers. Of the $1.269 billion slated to pay Medicare contractors next year, the committee report recommended "$165 million in user fees ... to charge providers to process paper claims and duplicate or unprocessable claims, and for initial and continued enrollment in the Medicare program." Committee spokesperson John Raffetto said senators "may push for passage of user fee legislation in conference" if the Senate Finance Committee does not act on the proposal. Federation of American Health Systems' Anne Berdahl said, "We're disappointed that the report language seemed to leave the door wide open" (9/7 issue).