United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2002-10-31 monographic deposited born digital 84 p. GA 1.13:GAO-03-180 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-03-180 P0b002ee180387ad2 f:d03180 DGPO 2010-08-12 2011-03-23 GAOREPORTS-GAO-03-180 machine generated eng fdlp REPORT GAOREPORTS-GAO-03-180 GAO-03-180 Beneficiaries Health care programs Managed health care Health maintenance organizations Federal Employees Health Benefits Program Other Written Product A05445

Since the early 1980s, health maintenance organizations (HMO) have entered into risk-based contracts with Medicare and offered beneficiaries an alternative to the traditional fee-for-service (FFS) program. By 1997, 5.2 million Medicare beneficiaries were enrolled in an HMO. Although Medicare HMOs were available in most urban areas, they were often unavailable in rural areas. Medicare+Choice (M+C) has HMO requirements pertaining to benefit package proposals, the beneficiary enrollment process, marketing and enrollee communication materials, and quality improvement, among other areas. An HMO must annually submit a benefit package proposal to the Centers for Medicare and Medicaid Services (CMS) for each M+C health plan that the HMO intends to offer. M+C requirements for the beneficiary enrollment process specify the information that an HMO must include in its enrollment application and the checks that it must perform to ensure that beneficiaries who submit applications are eligible to enroll in the HMO's health plan. M+C marketing requirements prohibit HMOs from using inaccurate or misleading language in advertisements or materials distributed to enrollees. M+C requirements for quality improvements specify that HMOs must undertake multiyear projects intended to improve the quality of health care and must routinely gather and report performance data to CMS. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-03-180/html/GAOREPORTS-GAO-03-180.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-03-180/pdf/GAOREPORTS-GAO-03-180.pdf GAO-03-180 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-03-180 Other Written Product GAO-03-180; Medicare+Choice: Selected Program Requirements and Other Entities' Standards for HMOs; Beneficiaries Health care programs Managed health care Health maintenance organizations Federal Employees Health Benefits Program Title 42 Section 1395w 42 U.S.C. 1395w Volume 111 Page 251 Volume 111 Page 282 Volume 111 Page 299 Volume 111 Page 320 111 Stat. 251 111 Stat. 282 111 Stat. 299 111 Stat. 320 Volume 113 Page 1501A 113 Stat. 1501A Volume 114 Page 2763A 114 Stat. 2763A Volume 116 Page 594 Volume 116 Page 696 116 Stat. 594 116 Stat. 696 Public Law 105-33 Public Law 106-113 Public Law 106-554 Public Law 107-108 Public Law 107-188