Question

Discuss key legal and regulatory issues in the government entitlement programs that affect health plans.

Answer 1

• The entitled program is established in a way, that the individual should be eligible for both Medicaid and Medicare.
• Medicare program was run by the federal government of the CMS which is responsible for policy regulation under U.S Department of Health and Human Services.
• But the claims and the benefits are undertaken by the intermediaries such as Social security administration.
• Medicare monthly benefits for medical services will require a monthly premium for obtaining of services.
• Medigap coverage is the issue with the Medicare health plan where the seniors were not covered by insurance.
• Another issue with the pilot plan program where the private market sells the insurance plans that do not cover in the traditional insurance coverage. For Example, the HMO plans that covers the prescription drugs.
• Balanced Budget Act was passed, but it is not beneficial for the individual as they already have the traditional plan and private plans.
• Later the Patient Protection and Affordable care act were designed, but it has a complicated risk of premium, cost-sharing, and coinsurance.
• Medication Therapy Management program targeted beneficiaries of the patient who require the high cost.
• The PFFS plan increases the payment rate especially preventive and the screening services.
• Medical saving account plan is not providing tax-free for the beneficiaries.
• Group retiring plan is one of the poor performing plans.
• Quality Improvement Organization reviewed the MA plan and reported the requirements needed for meeting the compliance in quality.