MEDICARE+Choice Final Rule From CCH Details Medicare Managed Care Regulations
(RIVERWOODS, ILL., August 3, 2000) Medicare celebrated its 35th anniversary
amid the same air of controversy that surrounded its birth in 1965, according to CCH
INCORPORATED (CCH), a leading provider of health law information and services and
e-learning programs. Although Medicare is now a prominent feature of the American social
landscape, it took decades to enact the national health insurance plan for senior citizens
and disabled persons. (For a history of the Medicare program, see the timeline at the end
of this release.)
Even today, regulators, legislators and members of the health care community struggle
with the issues of what services Medicare should cover, how seniors and disabled persons
should receive their health care and how the system should be regulated and financed.
Latest Program Option: Medicare+Choice
The newest option in the history of the Medicare program is Medicare+Choice. The
recently finalized regulation expands the role of managed care while at the same time
finetunes the payments made to managed care organizations. In addition, the rule makes
several changes to the benefits and protections provided under Medicare managed care.
As it has since the first Medicare law was enacted in 1965, CCH is offering
professionals expert guidance and authoritative source material to cope with the latest
New from CCH is the Medicare+Choice Final Rule book, providing valuable
explanations and guidance on the impact of the new rule on America's senior citizens and
managed care organizations, hospitals, long-term care facilities, physician practices,
health care attorneys and insurance companies. (368 pages, $69.00. To order call
1-888-449-9525 or visit the CCH online store at http://onlinestore.cch.com.)
In addition to the full text of the HCFA rule and the Medicare+Choice provisions as
published in the Code of Federal Regulations, Medicare+Choice Final Rule from
CCH contains an executive summary with explanation of rule provisions and a detailed table
of contents to help readers find critical information quickly.
"On July 31, just one day after Medicares 35th birthday, the
final rules became effective for Medicare+Choice. It still isnt at all clear,
however, whether the managed care industry can profitably meet consumer demand for quality
care serving a growing population of older enrollees with more serious and costly health
conditions than the average, non-Medicare managed care enrollee," said Jane
Harper-Alport, senior health law analyst for CCH.
Harper-Alport noted preliminary reports indicating that over 900,000 Medicare
beneficiaries currently enrolled in managed care plans will be affected by plan
withdrawals by managed care organizations that have announced their intention not to
participate in Medicare+Choice in 2001.
"Its also not clear how hospitals will adjust to the new prospective-payment
system for outpatient services, which took effect August 1. Many providers are seeking
assistance in implementing the new coding and reimbursement rules and may have to apply
for Medicare payments under a temporary government contingency plan if they cannot quickly
achieve clean claims under the new rule," Harper-Alport added.
Availability and Pricing
For more information or to purchase the Medicare+Choice Final Rule, call
1-888-449-9525 or visit the CCH online store at http://onlinestore.cch.com. Single copy price is $69 plus applicable
tax, shipping and handling. Quantity discounts are available.
About CCH INCORPORATED
CCH INCORPORATED, headquartered in Riverwoods, Ill., was founded in 1913 and has served
generations of business professionals and their clients. For more than 50 years, the
company has regularly tracked, reported, explained and analyzed health and entitlement law
for health care providers, insurers, attorneys and consumers. CCH is the premier provider
of Medicare and Medicaid information and publishes the industry standards, the CCH
Medicare and Medicaid Guide and the CCH Healthcare Compliance Portfolio, as
well as offers ComplianceEdge, the e-learning program for health care
compliance. CCH is a wholly owned subsidiary of Wolters Kluwer U.S. The CCH web site can
be accessed at www.cch.com. The CCH Health
web site can be accessed at http:\\health.cch.com.
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EDITORS NOTE: For members of the press, a complimentary review copy of Medicare+Choice
Final Rule is available by contacting: Leslie Bonacum, 847-267-7153 or email@example.com.
A HISTORY OF THE MEDICARE PROGRAM
Harry Truman sends a message to Congress asking for legislation establishing a
national health insurance plan.
Two decades of debate ensue, with opponents warning of the dangers of
By the end of Trumans administration he had backed off from a plan for universal
coverage, but administrators in the Social Security system and others had begun to focus
on the idea of a program aimed at insuring Social Security beneficiaries.
July 30, 1965:
Medicare and its companion program Medicaid, (which insures indigent recipients), are
signed into law by President Lyndon Johnson as part of his "Great Society."
Ex-president Truman is the first to enroll in Medicare.
Medicare Part B premium is $3 per month.
Disabled persons under age 65 and those with end-stage renal disease become eligible
Services expand to include some chiropractic services, speech therapy and physical
Payments to HMOs are authorized.
Supplemental Security Income (SSI) program is established for the elderly and disabled
poor. SSI recipients are automatically eligible for Medicaid.
Hospice benefits are added on a temporary basis.
Change from "reasonable cost" to prospective payment system based on
diagnosis-related groups for hospital inpatient services begins.
Most federal civilian employees become covered.
Remaining federal employees, including President, members of Congress and federal
judiciary, become covered.
Hospice benefits become permanent.
Major overhaul of Medicare benefits is enacted aimed at providing coverage for
catastrophic illness and prescription drugs.
Coverage is added for routine mammography.
Catastrophic coverage and prescription drug coverage are repealed.
Coverage is added for pap smears.
Physician services payments are based on fee schedule.
Medicare+Choice is enacted under the Balanced Budget Act. Some provisions prove to be
so financially restrictive when regulations are unveiled that Congress is forced to
revisit the issue in 1999.
Congress "refines" Medicare+ Choice and relaxes some Medicare funding
restrictions under the Balanced Budget Refinement Act of 1999.
Medicare+Choice Final Rule takes effect.
Prospective payment systems for outpatient
services and home health agencies take effect.
Medicare Part B premium is $45.40 per month.