Medicare program; Medicare+Choice program. Health Care Financing Administration (HCFA), HHS. Final rule with comment...

Area of Science:

• Health Policy
• Medicare Regulations
• Healthcare Administration

Background:

• The Medicare+Choice (M+C) program regulations were initially implemented via an interim final rule on June 26, 1998.
• Subsequent legislative changes, notably the Balanced Budget Refinement Act of 1999 (BBRA), necessitated further regulatory revisions.
• Previous interim rules concerning user fees for risk contractors and provider-sponsored organizations (PSOs) also informed these updates.

Purpose of the Study:

• To respond to public comments on the June 26, 1998, interim final rule for the Medicare+Choice (M+C) program.
• To implement necessary revisions to M+C regulations reflecting changes introduced by the Balanced Budget Refinement Act of 1999 (BBRA).
• To address comments on prior interim rules regarding user fees and provider-sponsored organizations.

Main Methods:

• Administrative rulemaking process, including responding to public comments.
• Regulatory analysis and revision based on legislative mandates (BBRA).
• Incorporation of feedback on user fees and PSO regulations.

Main Results:

• Final rule with comment period issued, incorporating revisions to M+C regulations.
• Key policy areas addressed include eligibility, enrollment, marketing, benefits, quality, payment, and provider participation.
• Revisions align M+C regulations with statutory changes from the BBRA, subject to public comment.

Conclusions:

• The final rule provides updated and revised regulations for the Medicare+Choice program.
• The revisions aim to clarify and improve the administration of M+C, incorporating legislative updates and public feedback.
• This regulatory action ensures M+C program compliance and addresses operational aspects for beneficiaries, providers, and contractors.