While providers and payers ponder whether hikes in Medicare payment rates to HMOs will increase Medicare HMO enrollment, the government is sure of it. So sure, in fact, it's anticipating unscrupulous behavior to lure beneficiaries into HMOs.
To help guard against that, HCFA last week published the agency's first-ever guide outlining how HMOs can market their products to Medicare beneficiaries.
The guide spotlights federal policymakers' heightened concern about the potential for marketing abuses as Medicare managed-care enrollment continues to grow.
The recently enacted federal balanced-budget law seeks to accelerate that enrollment in cost-controlling managed-care plans. It makes enrollment more attractive to Medicare beneficiaries by adding PPOs, provider-sponsored organizations and other types of plans to the Medicare HMO option now available.
The law also seeks to make it more attractive for managed-care plans to expand into rural areas by upping their payments (See story, p. 22).
In announcing the marketing guidelines last week, federal officials said beneficiaries will be protected from marketing chiselers.
"Beneficiaries will always be able to make informed choices about managed care," said HHS Secretary Donna Shalala.
Shalala announced the publication of the new guidelines at an American Association of Health Plans Medicare meeting last week in Washington.
Karen Ignagni, president and chief executive officer of the AAHP, applauded the guidelines, saying they reflected health plans' participation in their development.
The guidelines aim to speed HCFA's pre-approval of managed-care advertising and promotion material. They include standardized forms for managed-care plans to use for such functions as beneficiaries' summary of benefits and annual notification of premiums and benefits. HCFA gives plans an incentive to use the standard notification letters by allowing them to bypass HCFA pre-marketing review if they do so.
The guide also gives examples of language that is prohibited and permitted in marketing materials. For instance, a plan must make it clear to enrollees that they are required to use its participating providers and to continue paying their Medicare Part B premium even if they won't pay a premium for enrolling in the plan.
In describing their quality, Medicare managed-care plans are barred from using such superlatives as "best" or "highest" unless they can be substantiated, with the source of that quality rating disclosed in the advertisement.
The guidelines also prohibit plans from offering beneficiaries any more than $10 worth of promotional gifts or activities, including free medical tests at health fairs where plans' marketing personnel are present.
Plans also are barred from making sales presentations at health fairs, although they may offer pre-enrollment advertising materials and make plan representatives available for questions if the plan does not also enroll beneficiaries at the events.