tci Medicare Compliance & Reimbursement - 2003 Issue 21

Medicare+Choice: SOCIAL HMO PROGRAM COULD BE NEARING END

Medicare+Choice plans that have wanted to get in on Medicare's social HMO demonstration may never get that chance - and plans participating in other demonstrations are wondering if their days are numbered. The Medicare Payment Advisory Commission voted April 24 to recommend that Congress begin rolling the SHMO demo programs into the greater M+C program at the end of the year. SHMOs were launched in 1985 as a way to provide enhanced care to frail, chronically ill, functionally impaired seniors and help them remain independent and avoid institutionalization. Participating plans receive additional Medicare payments and "frailty adjustments" for these...

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