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MEDICARE+Choice Final Rule From CCH Details Medicare Managed Care Regulations

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 changes.

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 Medicare’s 35^th birthday, the final rules became effective for Medicare+Choice. It still isn’t 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 bonacuml@cch.com.

1945:
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 "socialized medicine."

By the end of Truman’s 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.

1972:
Disabled persons under age 65 and those with end-stage renal disease become eligible for coverage.

Services expand to include some chiropractic services, speech therapy and physical therapy.

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.

1982:
Hospice benefits are added on a temporary basis.

1983:
Change from "reasonable cost" to prospective payment system based on diagnosis-related groups for hospital inpatient services begins.

Most federal civilian employees become covered.

1984:
Remaining federal employees, including President, members of Congress and federal judiciary, become covered.

1986:
Hospice benefits become permanent.

1988:
Major overhaul of Medicare benefits is enacted aimed at providing coverage for catastrophic illness and prescription drugs.

Coverage is added for routine mammography.

1989:
Catastrophic coverage and prescription drug coverage are repealed.

Coverage is added for pap smears.

1992:
Physician services payments are based on fee schedule.

1997:
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.

1999:
Congress "refines" Medicare+ Choice and relaxes some Medicare funding restrictions under the Balanced Budget Refinement Act of 1999.

2000:
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.