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Archive for July 11th, 2008

First of all, here is a link to the full text of the Medicare Improvement for Patients and Providers Act of 2008.

Section 161 applies to the reduction in payment.

Section 162 applies to the requirement for PFFS and MSA plans to build a network in certain areas by 2011.  Here is a PDF of just section_162 (so you don’t have to surf through the whole bill to find it!)  The network requirement is waived where there are less than 2 other network products available in the county (Local PPO and/or HMO, this doesn’t apply to Regional PPO’s).  Not sure if 2 networks means two different companies or if one company could offer a high and a low version of a PPO/HMO and this would count as 2?  Since PPO/HMO plans tend to flourish more in Urban areas, this could help PFFS stay afloat in the rural areas of the country. 

However, if by 2 network plans, that could mean two plans offered by one company (many companies have 10 or more options with all of the prescription drug choices, etc.), then that would require the PFFS network requirement even in many rural areas.  I’ll look for some clarification.

Section 163 has to do with requiring PFFS and MSA to have a Quality Improvement Program like HMO’s and PPO’s.  This will be required by 2010, a year sooner than the network requirement.  I’ll talk to some carriers and see how big the impact of this requirement might be.

In summary, there are probably more questions than answers at this point.  We’re not talking about 2009 changes with respect to this bill (with respect to Medicare Advantage, at least).  At this point, I’ll probably be focusing more time on the CMS 2009 Call Letter which will address changes to marketing, such as, Levelized commissions, restrictions on outbound telemarketing, etc.

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