GOVERNMENTFederal plan may change Medicaid HMO payment ratesIf reimbursement increases result, physicians hope Medicaid health plans will pass some of the money on to them.By Leigh Page, AMNews staff. Feb. 19, 2001. Proposed federal changes in Medicaid HMO payments could help stabilize a shaky Medicaid managed care market, raise payments for doctors who treat sicker patients and help legitimize doctors' calls for "actuarially sound" physician reimbursement rates in the commercial HMO market. The changes were part of a larger set of Medicaid patient protections released in the last full day of the Clinton administration, then delayed for review by President Bush. The rules on Medicaid HMO payments are subject to a 60-day comment period because they were not part of the Clinton administration's original proposal. If the Bush administration has no changes, the entire package would become effective June 19. Basically, the payment proposal would remove the "upper payment limit" for calculation of Medicaid HMO reimbursements. That rule requires that reimbursements be at or below comparable Medicaid fee-for-service rates, according to officials with the Health Care Financing Administration. Under the new rule, HCFA would require payments to be actuarially sound, meaning that actuaries working for state Medicaid programs would have to certify that payments will cover legitimate costs of the HMOs and their contracted doctors and hospitals. But HCFA officials cautioned that the new standard would not necessarily mean that more money would go to Medicaid HMOs. They said actuaries could differ on what is "actuarially sound," allowing states to defend their current rates. Many states have been plagued with burgeoning Medicaid expenses and are leery of raising rates.
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Copyright 2001 American Medical Association. All rights reserved.
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