Medicare Managed Care

 

NASL 2022 Issue Briefs:

 

Expand Medicare Beneficiaries’ Access to Digital Health, Including Telehealth & Remote Patient Monitoring  (Feb 2022)

 

Support the Stabilizing Medicare Access to Rehabilitation and Therapy (SMART) Act of 2021 (H.R. 5536) (Feb 2022)

 

Hospital Observation Status Harms Beneficiaries' Access to Medicare's Skilled Nursing Benefit

 

The Balanced Budget Act of 1997 (BBA) established a new Part C of the Medicare program, known then as the Medicare+Choice (M+C), effective January 1999. As part of the M+C program, the BBA authorized CMS to contract with public or private organizations to offer a variety of health plan options for beneficiaries, including both traditional managed care plans (such as those offered by HMOs under §1876 of the Social Security Act) and new options that were not previously authorized. Four types of M+C plans were authorized under the new Part C of Medicare:
 

  • Coordinated care plans, including:
    • Health Maintenance Organizations (HMOs) (with or without Point-ofService options (POS));
    • Provider Sponsored Organizations (PSOs) and 
    • Preferred Provider Organizations (PPOs);
  • Medicare Medical Savings Account (MSA) plans;
  • Private Fee-for-Service (PFFS) plans; and
  • Religious Fraternal Benefit (RFB) plans.

Medicare Managed Care Manual

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