HCFA next month will publish the first version of an application that is supposed to make it easier for health plans and provider-sponsored organizations to join the new Medicare+Choice program.
According to a HCFA official, the "core application" will cover most of what must be included in the final application. Under the law that created the program, the final application form must be published by June 1, 1998.
There actually will be two core application forms. The one being published next month will cover all state-licensed health plans and PSOs. A second document for those PSOs that want a federal waiver from state regulations will come out soon after.
When the final regulation setting the application criteria for all plans is published in June, all existing Medicare health plans will be converted automatically to the new Medicare+Choice program and new plans can begin the certification process.
The problem for HCFA and for potential Medicare+Choice plans is there is little time between the release of the application criteria and a November 1998 "health information fair," when Medicare's 38 million beneficiaries are scheduled to be informed about available plan options. Of course, all plans want to be part of that first information mailing for competitive reasons, and HCFA officials have said recently they want to get a wide variety of plans up and running by that time.
The core application release was designed to make an expected rush next June easier. According to a HCFA official, plans should be able to get most of the way through the application process before next June.
"Then in June we will have a supplemental application, but we hope (plans) will only have to tweak their application," the official said.
What isn't clear is just how far along the application process a plan can get prior to June.
For example, according to the HCFA official, the agency has yet to determine if a plan will be able to undergo a site visit before the June deadline.
"A lot of that depends on how many applications we get," the official said.
Estimates of the number of potential applicants vary widely. At least one HCFA estimate put the number at several hundred but other estimates by private consultants have been lower.
Peter Grant, an attorney with Davis Wright Tremaine in San Francisco, said the early release of the draft application will send a positive message that HCFA wants to expedite the application process, but it also means plans must move quickly.
"This is a highly unusual effort on the part of HCFA to (hasten) these applications," Grant said. "This should have a strong influence on the industry in terms of the timing of the applications."