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Health plans in the Medicare+Choice program are expected to use much of this year’s $1 billion allocation of increased federal funding to boost payments to physicians and hospitals, say industry experts. However, this provider pay hike could be threatened by rumblings from legislators, according to Capitol Hill watchers.
Congress passed a Medicare "give-back" bill late last year that earmarked $11 billion over five years to strengthen Medicare+Choice, primarily by persuading health plans to remain in the four-year-old program. Of that amount, $6.2 billion was provided in direct payments to managed care plans, and just under $1 billion of that goes to plans in this calendar year.
"We are looking at shoring up our provider networks in certain markets," says Dick Brown, director of media relations at Humana Inc. in Louisville, KY. "We want to make certain we can keep providers in our Medicare+Choice networks and give our members the access that they want to the providers they need."
But there also is concern emerging from Congress about the give-backs. Rep. Fortney "Pete" Stark (D-CA), for instance, argues that not enough physicians were dropping out of Medicare+Choice to justify directing these extra dollars to them. Also, Rep. William Thomas (R-CA) likes the idea of using any extra funds to provide benefits directly to seniors.