Preferred provider org. (PPO) are more prevalent than other types of health plans, but, in 2003, only 6 PPOs contracted to serve Medicare beneficiaries (BE) in Medicare+Choice. The Centers for Medicare & Medicaid Services (CMS) initiated 2 demonstrations that include a total of 34 PPOs. This study: (1) describes how CMS used its statutory authority to conduct the 2 demo's., (2) assessed the extent to which demo. PPOs (DP) expanded access to Medicare health plans & attracted enrollees, (3) compared CMS's est. of out-of-pocket costs that BE incurred in DP with those of other types of coverage, incl. fee-for-service Medicare, M+C plans, & Medigap policies, & (4) determined the effects of DP on Medicare spending. Charts & tables.
Studies have found that Medicare payment rates for home oxygen exceeded other payers' rates. Congress has reduced home oxygen payment rates, capped rental payments after 36 months, and directed the Centers for Medicare & Medicaid Services (CMS), which administers Medicare, to use competitive bidding. This report examined Medicare home oxygen payment policy. It describes how Medicare pays for home oxygen; the effect on Medicare's payments of using other methodologies and rates; and changes in beneficiary access. The report reviewed industry-reported costs, Medicare claims data and payment data from selected private insurers, the VA, and CMS's competitive bidding program. Illustrations. This is a print on demand report.