New Medicare appeal rules; federal court ruling may force even more revisions

Article Abstract:

The Dept of Health & Human Services issued new rules for Medicare appeals in Apr 1997, and on May 2 the agency appealed an Arizona district court order requiring changes in the Medicare rules. Faster settlement of appeals would be required by both the new rules and the court decision. However, the government rules do not require continued treatment during the appeals process, but the court order includes this provision plus additional measures such as requiring a health plan to give notice in writing of reductions in services.

Management, Cases, United States. Centers for Medicare and Medicaid Services, United States. Department of Health and Human Services

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Lawmakers mull how best to regulate Medicare PSOs

Article Abstract:

Legislators are debating how best to regulate provider-sponsored organizations (PPOs), which they now accept as potential Medicare contract partners. The two main issues of the debate are whether states or the federal government should be responsible for regulating the entities, and what their solvency standards should be. PPOs networks of doctors and hospitals will be politically competing with health insurers and state regulators in the debate.

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