CBO's analysis of regional preferred provider organizations under the Medicare Modernization Act

Original publisher: [Washington, D.C.] : Congress of the U.S., Congressional Budget Office, [2004] OCLC Number: (OCoLC)71375679 Subject: Pharmaceutical services insurance -- United States. Excerpt: ... CBO'S ANALYSIS OF REGIONAL PREFERRED PROVIDER ORGANIZATIONS UNDER THE MEDICARE MODERNIZATION ACT 7 Table 1. Changes in the Percentage of Medicare Beneficiaries Enrolled in Private Plans and Increases in Payment Rates, 1997 to 2003 Ratio of M + C Percentage of Percentage Increase in Payment Rate Medicare Beneficiaries a Percentage of Enrolled in Private Plans Average per Capita FFS Payment Rates, to per Capita FFS Expenditure per Month in 2003 Beneficiaries 1997 to 2003 Expenditures, 2003 1997 2003 Less Than $ 400 2.9 66.8 1.36 0.5 1.8 $ 400 to $ 449 9.2 49.7 1.23 5.9 6.2 $ 450 to $ 499 16.5 40.1 1.14 6.1 6.2 $ 500 to $ 549 19.4 26.8 1.05 11.4 9.7 $ 550 to $ 599 14.7 20.9 0.98 12.6 9.4 $ 600 to $ 649 12.6 17.2 0.94 18.4 12.9 $ 650 and Higher 24.8 14.2 0.96 22.4 19.1 ____ Total 100.0 24.7 1.04 13.5 11.3 Source: Congressional Budget Office based on data from the Centers for Medicare and Medicaid Services. Notes: CBO weighted the payment rates and per capita FFS expenditures by the number of beneficiaries in each U.S. county and used those weighted averages to calculate the changes in payment rates and the ratio of M + C payment rates to per capita FFS expenditures. FFS = fee for service; M + C = Medicare + Choice. a. In 1997, private plan enrollees were beneficiaries enrolled in Medicare risk plans. In 2003, they were beneficiaries enrolled in M + C plans. plans in rural areas and other areas where per capita FFS The Medicare Modernization Act included provisions spending is low. that affected the incentives for private health plans to of-fer a PPO option to Medicare beneficiaries on a region-wide basis beginning in 2006. The law requires that CMS The MMA's Regional PPO Program establish at least 10 regions but no more than 50 and that Preferred provider organizati...