WASHINGTON – The debate over H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, was focused on removing the Medicare physician payment cuts and a battle of wills between Congress and President Bush, who had vetoed it before Congress overrode his veto.
HR 6331’s impact, however, may be felt in other areas and could create significant disruptions for health plans, according to Stephen Wood, managing principal and Reden & Anders.
HR 6331 requires that new Special Needs Plans (SNPs), which were created by the Medicare Modernization Act to target those who are dually eligible for Medicare and Medicaid, have a contract with the state to deliver Medicaid services.
“The problem is that very few states have a dually eligible plan,” Wood said. “HR 6331 doesn’t mandate states to adopt these laws to enable dual eligible products.”
New York State is one of the few states that have such plans. The problem, said Christopher Palmieri, executive director of Medicare for VNS CHOICE, is that the state’s integration model of Medicaid into Medicare Advantage doesn’t appeal to consumers. Therefore, there is no incentive to move out of the member’s Medicare Advantage plan.
“All the supplemental benefits of Medicare Advantage plans would all go away if you move to the integrated plan,” he said. Another problem is that HR 6331 is not specific about the level of integration, he said.
Palmieri said states need to come together with the Centers for Medicare and Medicaid Services and health plans and trade groups need to work with the states to create a product that dovetails with or wraps around the Medicare Advantage plans.
Robert Zirkelbach, spokesman for America’s Health Insurance Plans, said the trade association supports health plans making a “good faith effort” to coordinate with state Medicaid programs for the SNPs.
When that will occur is not certain, although Palmieri said the issue is being discussed informally among stakeholders in New York. What could speed discussion may be state budgetary concerns, given that cost containment is one of the drivers for developing integration models.