The Direct Payment Method for Medicare Managed Care Plans: A Concept Paper

The Direct Payment Method for Medicare Managed Care Plans

A report on enrollment: rural Medicare beneficiaries in Medicare+Choice plans.

The Medicare+Choice program was created by the Balanced Budget Act (BBA) of 1997 (Public Law 105-33), signed into law by President Clinton in August 1997. The legislation changed the method for computing capitation rates paid to Medicare+Choice plans, beginning in January 1998. The initial impact was on managed care plans that had been active prior to the BBA, but new Medicare+Choice plans, whi...

Overview of employer capitation activities

This article addresses a new initiative of the Health Care Financing Administration (HCFA) to contract on a group basis with: employer self-insurance plans, unions, group health insurance companies, and Taft-Hartley Health and Welfare Funds for groups of Medicare beneficiaries. under this new concept, Medicare beneficiaries may elect in the future to obtain Medicare coverage through their group...

Volatility in Medicare AAPCC rates: 1990-1997.

As Medicare beneficiary enrollment in managed care plans increases, and as Congress considers relying on capitation for achieving savings in the program, the question of finding a fair and equitable formula for determining the monthly payment to managed care plans has become increasingly salient. This DataWatch focuses on one dimension of using previous expenditures to determine annual capitati...

Risk-Adjustment System for the Medicare Capitated ESRD Program

Medicare is the principal payer for medical services for those in the U.S. population suffering from end-stage renal disease (ESRD). By law, beneficiaries diagnosed with ESRD may not subsequently enroll in Medicare Advantage (MA) plans, however, the potential benefits of managed care for this population have stimulated interest in changing the law and developing demonstration plans. We describe...