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Copyright (c) 1996 Kansas Law Review, Inc.
Kansas Law Review

BIBLIOGRAPHY: Annotated Bibliography: Medicare and Managed Care

July, 1996

44 Kan. L. Rev. 793


Gail D. Edson



Recent proposed changes in health care reimbursement methods threaten both access to and delivery of services to the low-income and elderly populations. Managed care plans have seen an influx of Medicare beneficiaries as a result of promises of cost-saving potential to beneficiaries and government programs. Over 2.3 million beneficiaries enrolled in managed care plans in 1995, doubling the number of Medicare managed care beneficiaries enrolled in 1993. 1 While these programs often offer reduced co-payments and deductibles for members, beneficiaries face severe restrictions on providers and services usually covered under fee-for-service Medicare. 2 Data show that contract benefits are frequently denied with little or no opportunity for appeal and that beneficiaries are rarely informed of their due process rights. 3 Disabled and older adults are often coerced into joining managed care plans with little actual information about the benefits provided.

In 1982, with the passage of the Tax Equity and Fiscal Responsibility Act (TEFRA), Congress mandated the provision of managed care plan options to Medicare beneficiaries. 4 The statute allows Medicare beneficiaries to enroll in risk or cost contract Health Maintenance Organizations (HMOs), or Competitive Medical Plans (CMPs) which offer a limited benefit plan. The plans contract with Medicare's administrative agency, the Health Care Financing Administration (HCFA) to provide Medicare benefits. In exchange for their participation, the plans receive a capitated payment to cover the cost of care to beneficiaries. 5 The structure provides incentives for plans to keep utilization of services to a minimum. ...
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