Brock T H
Proskauer Rose LLP, Washington, DC, USA.
Healthc Financ Manage. 1998 Mar;52(3):48-52.
The Medicare + Choice program, a feature of the Balanced Budget Act of 1997, has far-reaching implications for healthcare providers, and for provider-sponsored organizations (PSOs), in particular. Under Medicare + Choice, PSOs will be able to contract with Medicare if they meet certain conditions. Most significantly, the PSO must be established, operated, and majority-owned by healthcare providers that directly furnish a substantial portion of the covered services. PSOs and other participants in the Medicare + Choice program will receive aggregate annual payments based on geographic location and demographic characteristics of enrollees. Medicare + Choice provider participants should understand the details of how these payments will be calculated. For instance, geographically based payments will gradually be modified to reflect a more uniform payment rate nationally. In addition, participants in Medicare + Choice will need to meet state solvency requirements or apply to HCFA for a three-year waiver of those requirements to participate in the program. The best time to form a PSO may be in the next three years, before HCFA's authority to grant such waivers expires.
“医疗保险+选择”计划是1997年《平衡预算法案》的一项内容，对医疗服务提供者，尤其是对提供者赞助组织（PSO）具有深远影响。根据“医疗保险+选择”计划，PSO若满足某些条件，将能够与医疗保险机构签订合同。最重要的是，PSO必须由直接提供大部分承保服务的医疗服务提供者设立、运营并拥有多数股权。PSO及“医疗保险+选择”计划的其他参与者将根据参保人的地理位置和人口特征获得年度总付款。参与“医疗保险+选择”计划的医疗服务提供者应了解这些付款的计算细节。例如，基于地理位置的付款将逐步调整，以反映全国更统一的付款率。此外，“医疗保险+选择”计划的参与者需要满足州偿付能力要求，或向医疗保健财务管理局（HCFA）申请豁免这些要求以参与该计划三年。组建PSO的最佳时机可能是在未来三年内，在HCFA授予此类豁免的权力到期之前。
