1 edition of Health maintenance organization risk contracting under Medicare found in the catalog.
Health maintenance organization risk contracting under Medicare
David E. Edman
by U.S. Dept. of Health and Human Services, Health Care Financing Administration, Office of Research and Demonstrations, For sale by the Supt. of Docs., U.S. G.P.O. in Baltimore, Md, Washington, D.C
Written in English
|Series||Health care financing grants and contracts report, HCFA pub -- no. 03184., Health care financing grants and contracts report, HCFA pub -- no. 03184.|
|Contributions||Weiss, David L., Friedlob, Alan, United States. Health Care Financing Administration. Office of Research and Demonstrations, Jurgovan and Blair, Inc|
|LC Classifications||RA413.5.U5 H44 1984|
|The Physical Object|
|Pagination||152 p. :|
|Number of Pages||152|
Medicare risk contract Managed care An HMO-like format for delivering care under Medicare in which a Pt/client pays a flat fee to a Medicare risk contractor, which is then responsible for delivering health care; a person covered under an MRC receives only listed services provided by listed providers. Such plans most frequently focus on providing inpatient mental health or combined mental health and substance abuse inpatient benefits. PIHPs provide services on the basis of capitation payments or payment arrangements other than state plan payment rates but do not have a comprehensive risk contract.
Bundled Payment Stop Loss provides protection for health care providers who have accepted risk under a bundled model. Most often, this risk is through either a CMS program such as BPCI or through a commercial payor contract. This coverage provides protection for any procedure that exceeds a defined percentage of the target amount. Do Medicare HMOs Reduce Fee-for-Service Costs? a September report by Price Waterhouse for the Group Health Association of America (GHAA), estimates that if Medicare risk-contract HMO.
value of health care through arrangements in which health care providers and payers work together through sharing financial risk (i.e., payment reform) to better align incentives to provide quality care at more affordable prices. Although the idea of integrated delivery systems and providers taking on risk is not new. The Secretary shall also provide for appropriate modifications of contracts with health maintenance organizations under section (i)(2)(A) of the Social Security Act [42 U.S.C. mm(i)(2)(A)] (as in effect before February 1, ), under section (a) of the Social Security Amendments of [42 U.S.C. b–1(a)], or under section
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Get this from a library. Health maintenance organization risk contracting under medicare. [United States. Health Care Financing Administration. Office of Research and Demonstrations.; Jurgovan and Blair, Inc.;]. Health Care Financing Administration. Office of Research and Demonstrations.; Jurgovan and Blair, Inc.
Title(s): Health maintenance organization risk contracting under Medicare. Country of Publication: United States Publisher: Baltimore, Md.: U.S. Dept. of Health and Human Services, Health Care Financing Administration, Office of Research and. Read about HMO plans, which require you to go to doctors, other health care providers, or hospitals on the plan's list, unless you need emergency care.
You may also need to get a referral from your primary care doctor to see a specialist. If you want Medicare Prescription Drug Coverage (Part D), you must join an HMO that offers prescription drug coverage. Under Medicare + Choice, several types of coordinated care plans are eligible to contract with the Health Care Financing Administration (HCFA) to provide coverage to Medicare beneficiaries.
 This expands and modifies the Medicare health maintenance organization (HMO) risk-contracting program formally begun in January As part of the M+C program, the BBA authorized CMS to contract with public or private organizations to offer a variety of health plan options for beneficiaries, including both traditional managed care plans (such as those offered by Health Maintenance Organizations (HMOs) under § of the Social Security Act) and new.
A Health Maintenance Organization (high and basic option). IMPORTANT This means you do not need to enroll in Medicare Part D and pay extra for. Introduction – Tufts Health Plan such as Tufts Associated Health Maintenance Organization. Inc. (“Tufts Health Plan”). Tufts Health Plan entered into a Medicare risk contract with.
role of private health plans in Medicare. intrODUCtiOn. Medicare’s risk contracting program has been operational sincefollow ing passage of the Tax Equity and Fiscal Responsibility Act of (TEFRA). Under TEFRA, risk contracts were entered into by health maintenance organizations (HMOs), which received capitation payments in.
The Tax Equity and Fiscal Responsibility Act (TEFRA) of (Public Law ) provided new incentives for health maintenance organizations (HMO's) to enroll Medicare beneficiaries on an at-risk basis. 1 TEFRA provisions encouraging HMO participation in Medicare on an at-risk basis sought to further the goals of promoting competition and cost effectiveness, and.
A Synthesis of Research Findings on the Operations and Performance of Health Maintenance Organizations. Rockville, Md.: Prepared for the National Center for Health Services Research under Contract No. [Google Scholar] Luke R, Brown B. Analysis Plan for the Study of Quality Assurance Programs in Medicare HMO's.
At the option of the contracting cost-based HMO/CMP, CMS will pay (through the FFS system) hospitals and SNFs for covered services furnished the organization’s Medicare enrollees in accordance with §(v) or of the Act, as applicable.
Name two types of health maintenance organization plans that may have Medicare Part B contracts. HMO Risk Plan and HMO Cost Plan The federal laws establishing standards of quality control and safety measures in clinical laboratories are known as The CLIA of (Clinical Laboratory Improvement Amendment).
A health maintenance organization (HMO) is a network or organization that provides health insurance coverage for a monthly or annual fee.
An HMO is made up of a group of medical insurance. Robert M. Keenan, III (Editor, Project Chair, and author of Chapter 1, Introduction: Basics of Contracting and Negotiating) is a partner with King & Spalding and advises health systems, hospitals, home health companies, pharmacy benefit management companies, pharmaceutical and medical device companies, physician organizations and managed care companies on a.
Figure - Health Maintenance Organization (HMO) and Cost Contract Enrollment Growth: Selected Calendar Years Figure - Percent of Medicare Population with Access to at Least One Risk/Medicare+Choice/Medicare Advantage Coordinated Care Plan (CCP): Calendar Years Implications for Medicare Risk Contracting.
The Medicare risk program has increased beneficiaries' range of choices in health care delivery systems, and risk plans do appear to be able to reduce utilization rates without affecting the quality of care. However, the primary goal of the risk program—to reduce costs to HCFA —has not been realized.
Table and Figure Descriptions:Table - Health Maintenance Organization (HMO) and Cost Contract Enrollment Growth: Selected Calendar Years Table - Percent of Medicare Population with Access to at Least One Risk/Medicare+Choice (M+C)/Medicare Advantage (MA) CCP (), Private Fee-for-Service (PFFS) (), or M+C/MA.
(21) “Health care risk contract” means a contract under which an individual or entity receives consideration or other compensation in an amount greater than 1 percent of the health maintenance organization’s annual gross written premium in exchange for providing to the health maintenance organization a provider network or other services.
Under Medicare + Choice, several types of coordinated care plans are eligible to contract with the Health Care Financing Administration (HCFA) to provide coverage to Medicare beneficiaries. This expands and modifies the Medicare health maintenance organization (HMO) risk-contracting program formally begun in HEALTH MAINTENANCE ORGANIZATION (HMO) (MEDICARE) A health coverage option offered by private insurance companies approved by and under contract with Medicare.
It includes Part A, Part B, and usually other coverage, such as prescription drugs. RISK. Health Maintenance Organization. HMOs are corporations licensed under the insurance laws of the state in which they operate and which assume financial responsibility for providing a defined set of medical services to their enrollees in return for a fixed premium.
From: Physical Rehabilitation's Role in Disability Management, Related terms. The health status of Medicare beneficiaries enrolled in HMOs is of continuing interest to policymakers.
Under current law, HMOs entering into risk-based contracts with the Medicare program are paid a monthly capitated amount for each enrollee, regardless of the amount of .A competitive medical plan (CMP) is an HMO that meets _____ eligibility requirements for a Medicare risk contract, but is not licensed as a _____ qualified plan.
federal; federally The Preferred Provider Health Care Act of ______restrictions on preferred provider organizations (PPOs) and allowed subscribers to seek health care from.(21) “Health care risk contract” means a contract under which an individual or entity receives consideration or other compensation in an amount greater than 1 percent of the health maintenance organization’s annual gross written premium in exchange for providing to the health maintenance organization a provider network or other services, which may include administrative services.
The 1-percent threshold shall be calculated on a contract-by-contract .