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To: Bobby Yellin who wrote (20380)	10/2/1998 7:16:00 PM
From: goldsnow	Respond to of 116756

Talking about Inflation: Good Night America...Would be saviors... HMOs Rebel Against Medicare Rules 07:05 p.m Oct 02, 1998 Eastern By Maggie Fox, Health and Science Correspondent WASHINGTON (Reuters) - Health maintenance organizations (HMOs) rebelled against the government Medicare program Friday and several dumped Medicare coverage, saying they could not afford to take part next year. But the government said it would not be bullied into making a rushed decision on the HMOs' demands to be allowed to raise some costs and cut some benefits, and said some of their proposals could result in higher rates for the six million Americans who get their Medicare benefits through HMOs. Medicare is a state and federal government health insurance plan for older Americans. The HMOs' decision meant several hundred thousand elderly Medicare clients would have to go back to the more expensive fee-for-service program in 1999, and could mark the start of an exodus of HMOs from Medicare, the American Association of Health Plans (AAHP) said. ''If there aren't some changes made, we see the plans being made to pull out as tip of iceberg,'' Susan Pisano, a spokeswoman for the AAHP, which lobbies on behalf of HMOs, said in a telephone interview. ''We asked the administration to allow plans a small window to make modest changes,'' Pisano added. For example, she said, they wanted to increase co-payments for prescriptions -- the amount a client contributes to the cost -- to $3 to $5 from $2 or $3. ''It would make the difference between staying in and getting out in some counties,'' Pisano said. The Health Care Financing Administration (HCFA), a branch of the U.S. Health and Human Services Department (HHS), rejected that. ''Under this proposal virtually all of the six million beneficiaries currently enrolled in Medicaid managed care plans could pay more premiums and cost sharing while potentially receiving reduced benefits,'' Nancy-Ann Min DeParle, administrator of HCFA, said in a letter mailed to the AAHP Thursday. She said the HMO demands would force a ''rushed review of potentially hundreds of provisions.'' Friday was the deadline for HMOs to tell HCFA if they were taking part in Medicare coverage for next year. United HealthCare Corp. said it was withdrawing coverage from 86 of the 206 counties it covered, affecting 59,000, or 13 percent of its 440,000 Medicare members. ''Inadequacies in the Medicare reimbursement system, uneven provider support and challenges from our own expansion strategy prompted this difficult, but necessary, action,'' said Jeannine Rivet, chief executive of United HealthCare's Health Care Services segment. Aetna U.S. Healthcare and Blue Cross and Blue Shield of Minnesota also said they were pulling out of part of their coverage. ''What we're dealing with here is a domino effect,'' Deborah Glass, vice president of government programs at Blue Cross and Blue Plus, said in a statement. She said there were questions about how HCFA calculated what it paid HMOs for their Medicare coverage, and said many of the HCFA regulations were too unclear. Medicare patients can still get coverage, but it is generally cheaper to go through an HMO for Medicare, in part because such organizations stress cost-effectiveness. Pisano said plans in 19 states and the District of Columbia had announced they were reducing Medicare participation in some way. ''Those plans take care of at least 260,000 people,'' she said. Michael Hash, deputy administrator of HCFA, said his agency had given careful consideration to the HMOs' requests. ''We are not convinced that it would be in the best interest of beneficiaries to allow almost all HMOs to increase costs and decrease benefits to their Medicare enrollees,'' Hash told a hearing Friday of the House Commerce Subcommittee on Health. Copyright 1998 Reuters Limited.