Reacting to HMOs' announcements that they will withdraw from the Medicare market, Congress will consider revisions to the Medicare+Choice program next year, a top Republican aide said last week.
Kathy Means, chief Republican health analyst for the Senate Finance Committee, said members want to examine a number of issues: regulation of Medicare HMOs, the time frame for plans to submit their premium and benefit information to HCFA, beneficiary education, payment rates and risk adjustment.
Health plans have cited several reasons for withdrawing from Medicare, such as the costs of regulation and beneficiary education, anticipated payment reductions under risk adjustment and slow growth in reimbursement under Medicare+Choice.
Some 45 plans nationwide have said they will drop out of Medicare, and 54 will reduce services; 400,000 beneficiaries will be affected.
"We're going back to the drawing board because of the large number of plan withdrawals," Means said during a forum on 1999 national healthcare issues.
Other congressional aides predicted last week that 1999 would see a repeat, or possibly an acceleration, of 1998 withdrawal notifications.
Means said Republicans on the finance committee may propose legislation to delay risk adjustment, under which health plans would be paid more for enrolling sicker beneficiaries.
HCFA's risk-adjustment formula relies largely on inpatient hospital data. Means said the formula should include more data from primary-care and post-acute settings because Medicare+Choice plans are responsible for care in those settings.
Her concerns are mirrored in a Dec. 9 letter from the American Association of Health Plans to HCFA Administrator Nancy-Ann DeParle. The AAHP, which objects to the formula, asked for a delay in adjusted payments until after the implementation date of Jan. 1, 2000.