Complaints spur changes in Medicare+Choice rules

New regulations not as strict on providers

With the new Medicare+Choice program scheduled to go into effect Jan. 1, both congressional and health care groups are still working to revise the program’s proposed regulations.

For instance, Rep. Mike Bilirakis (R-FL), chair of the House Commerce Health and Environment Subcommittee, says the interim Medicare+Choice rule is an "overly expansive interpretation of the Balanced Budget Act which runs counter to congressional intent. Thus far, HCFA has demonstrated a fundamental misunderstanding of the goal and spirit of the Medicare+Choice program."

In response, HCFA officials tell Physician’s Payment Update they are not going to raise Medicare+Choice fees, but the agency is willing to make adjustments in other areas. Specifically, in contrast to the proposed rule, the final Medicare+Choice regulations will:

—phase in the new Medicare+Choice quality improvement requirements, rather than instantly institute them;

—reduce the number of performance improvement projects required of plans;

—increase flexibility in coordinating care and conducting site visits for provider credentialing;

—allow plans an additional year to implement compliance plans and execute contracts with current providers.

As of Sept. 28, HCFA had 48 pending applications for new Medicare+Choice contracts and 25 pending applications for service area expansions from existing contractors. Four of the applications are from provider-sponsored organizations, and two additional provider-sponsored organizations have waiver requests pending. The agency has only received one application from a preferred provider organization, but no applications from medical savings account or fee-for-service plans.