United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1999-04-12 monographic deposited born digital 37 p. GA 1.13:HEHS-99-92 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-92 P0b002ee1803869d6 f:he99092 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-99-92 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-92 HEHS-99-92 Managed health care Health care services Health insurance Health services administration Comparative analysis Information disclosure Marketing Consumer protection Beneficiaries Standards and standardization Medicare Choice Program Federal Employees Health Benefits Program Letter Report HEHS Pursuant to a congressional request, GAO provided information on the Medicare Choice program, focusing on: (1) the extent to which managed care organizations' (MCO) member literature provides beneficiaries with accurate and useful plan information; and (2) whether the Health Care Financing Administration's (HCFA) review process ensures that beneficiaries can rely on MCOs' member literature to make informed enrollment decisions. GAO noted that: (1) although HCFA had reviewed and approved the materials GAO examined, all 16 MCOs in GAO's sample from four HCFA regions had distributed materials containing inaccurate or incomplete benefit information; (2) almost half of the organizations distributed materials that incorrectly described benefit coverage and the need for provider referrals; (3) one MCO marketed (and provided) a prescription drug benefit that was substantially less generous than the plan had agreed to provide in its Medicare contract; (4) moreover, some MCOs did not furnish complete information on plan benefits and restrictions until after a beneficiary had enrolled; (5) other MCOs never provided full descriptions of plan benefits and restrictions; (6) although not fully disclosing benefit coverage may hamper beneficiaries' decisionmaking, neither practice violates HCFA policy; (7) as GAO has reported previously, it was difficult to compare available options using member literature because each MCO independently chose the format and terms it used to describe its plan's benefit package; (8) in contrast, the Federal Employees Health Benefits Program's (FEHBP) plans are required to provide prospective enrollees with a single comprehensive and comparable brochure to facilitate informed enrollment choices; (9) the errors GAO identified in MCO's member literature went uncorrected because of weaknesses in three major elements of HCFA's review process; (10) limitations in the benefit information form (BIF), the contract form that HCFA reviewers use to determine whether plan materials are accurate, led some reviewers to rely on the MCOs themselves to help verify the accuracy of plan materials; (11) additionally, HCFA's lack of required format, terminology, and content standards for member literature created opportunities for inconsistent review practices; (12) according to some regional office staff, the lack of standards also increased the amount of time needed to review materials, which contributed to the likelihood that errors could slip through undetected; (13) HCFA's failure to ensure that MCOs corrected errors identified during the review process caused some beneficiaries to receive inaccurate information; and (14) HCFA is working to revise the BIF and develop a standard summary of benefits for plans to use--steps that will likely improve the agency's ability to review member literature and other marketing materials--but other steps could be taken to improve the usefulness and accuracy of plan information. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-92/html/GAOREPORTS-HEHS-99-92.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-92/pdf/GAOREPORTS-HEHS-99-92.pdf GAO/HEHS-99-92 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-92 Letter Report GAO/HEHS-99-92; Medicare + Choice: New Standards Could Improve Accuracy; Managed health care Health care services Health insurance Health services administration Comparative analysis Information disclosure Marketing Consumer protection Beneficiaries Standards and standardization Medicare Choice Program Federal Employees Health Benefits Program Public Law 105-33 Title 42 Part 422.100 42 CFR Part 422.100