While Republican leaders work to craft a managed-care regulation bill for patients covered by private insurance, the Clinton administration is extending a number of the same patient protections to beneficiaries enrolled in Medicare risk plans.
The new rules were included in the proposed Medicare+Choice regulations released by HCFA last week (June 22, p. 4). The regulations, which were scheduled to be published in the Federal Register last week, will take effect next month.
The regulation sets the groundwork for health plans, including HMOs, PPOs and provider-sponsored organizations, that want to participate in Medicare (See related stories, p. 32).
Many of the new HCFA requirements are also among the recommendations for managed-care reform of the House GOP healthcare task force, which released its proposal last week (See story, p. 2).
Like that proposal, the Medicare+ Choice rules would:
Allow women to see an OB/GYN for routine services without first going through a gatekeeper.
Allow patients with serious illnesses access to specialists without first seeing a primary-care physician.