Medicare managed-care plans would be given an extra two months to file their benefits and premium proposals with HCFA under a draft legislative proposal released last week by two top senators.
Plans would have until July 1 to submit to HCFA their "adjusted community rate" filings for the following year under the legislative draft circulated last week by Senate Finance Committee Chairman William Roth (R-Del.) and Sen. Daniel Patrick Moynihan (D-N.Y.), the committee's senior Democrat. A 1997 law sets May 1 as the filing date.
The change was sought by Medicare HMOs, which said May 1 was too early to predict costs for the following year, making it difficult to determine premiums they should charge and benefits they should offer.
For plans that terminate their Medicare+Choice contracts, the draft also would reduce the exclusion period to three years from five years.
The Roth-Moynihan proposal, dubbed the Medicare+Choice Program Improvement Act of 1999, includes other technical changes aimed at protecting beneficiaries enrolled in plans that withdraw from Medicare and reducing some of the regulatory burdens that plans said contributed to their withdrawals.
About 6 million Medicare beneficiaries are enrolled in 300 plans. Last year, 45 plans withdrew and 54 reduced service areas, affecting 400,000 beneficiaries in 407 counties.
Proposed changes include reducing Medicare+Choice plans' responsibility for funding a campaign to educate beneficiaries about health plan choices.
Health plans entirely pay for that campaign, but under the Roth-Moynihan proposal, they would be responsible for only the portion of Medicare beneficiaries enrolled in Medicare+Choice plans.
The legislation would authorize spending up to $150 million in 2000 on that beneficiary-education campaign.
Meanwhile, HCFA's formula for reducing the Medicare+Choice capitation payments for healthy beneficiaries and increasing them for sicker beneficiaries is "actuarially sound," according to the American Academy of Actuaries.
In testimony before the House Ways and Means Committee's health subcommittee, the academy said HCFA's "risk adjuster," which uses data only from inpatient claims to calculate patients' likelihood of having high medical costs, should also incorporate outpatient data.
Health plans have criticized HCFA's method because it does not include outpatient data.
HCFA will begin using the risk adjuster in calculating capitation payments Jan. 1, 2000.