HCFA has decided to slow the rollout of its new Medicare beneficiary handbook, which means health plans that want to begin enrolling seniors in Medicare risk products this fall will have to go it alone in marketing.
The handbooks are supposed to help Medicare beneficiaries find their way through the new Medicare+Choice program, which was created by the Balanced Budget Act of 1997 to provide managed-care options to Medicare recipients.
The guides will explain the coverage options available, such as HMOs, PPOs, provider-sponsored organizations, medical savings accounts and point-of-service plans.
HCFA also plans for each guide to include an insert that will explain the plans available in a given area.
About 100 sets of comparative data from around the country will be included in different versions of the handbooks, according to Michael Hash, HCFA deputy administrator.
Earlier this month, Hash told the House Ways and Means health subcommittee that HCFA would spend about $35 million to send all 38 million Medicare beneficiaries a copy of the new handbook.
But later, members of Congress criticized the handbook after Sen. John Breaux (D-La.) said the comparative data would confuse seniors and lead them to complain to HCFA and Congress. Breaux is chairman of the National Bipartisan Commission on the Future of Medicare.
In addition, a recent study released by the American Association of Retired Persons found most seniors are confused about the differences between traditional fee-for-service Medicare coverage and Medi-care HMOs.
HCFA also found some of the same problems when it did its own testing, Hash said. Therefore, HCFA has decided to scale back the project, he said.
Beginning this fall, about 5.5 million beneficiaries in five states will receive the first handbooks. Those states are Arizona, Florida, Ohio, Oregon and Washington. The states were chosen to offer a mix of urban and rural areas, and high and low managed-care penetration.
"It's desirable to have more focus testing and learn from that before we distribute (the handbook) to all 38 million," Hash said.
Another reason for the delay is logistical. To have the handbooks printed by the original release deadline of October, the prototypes should have been at the printer by June 15, a deadline Hash said HCFA couldn't meet.
The rollout of the handbooks is expected to be done incrementally and completed by midsummer of next year, Hash said. There is no specific schedule for distribution.
Sen. Charles Grassley (R-Iowa), chairman of the Senate Special Committee on Aging, criticized the decision to delay the handbooks.
"While we may agree that it is important to carefully monitor and evaluate beneficiaries' understanding of material, I have serious concerns that Medicare beneficiaries will not receive the information needed to evaluate their healthcare needs in a timely manner," Grassley said in a letter to HHS Secretary Donna Shalala. "Seniors need good, objective information about their healthcare options. Glossy sales pamphlets from managed-care plans just won't do the job."
Health plans, including PSOs, can begin enrolling Medicare beneficiaries under the new Medicare+Choice program later this year. However, for most of the country, the plans will not have the benefit of the Medicare handbook to inform beneficiaries of their options.
"This means it is basically business as usual," said Debbie Ahl, chief operating officer of Olympic Health Management Systems, which advises clients creating Medicare+Choice plans. "It is hard to say if (the handbook) will be a help or a hindrance for plans when it is sent out. It depends on how it is presented."