A bill to amend section 1876 of the Social Security Act with respect to administration of the medicare program in enrollments and disenrollments from health maintenance organizations and competitive medical plans and for other purposes.

Summary

Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services to: (1) notify, monthly, the appropriate agencies, organizations, and carriers of enrollments in and disenrollments with health maintenance organizations (HMOs) and competitive medical plans (CMPs); (2) establish a procedure whereby providers of services and other participating entities can obtain enrollment and disenrollment information; (3) provide that enrollments and disenrollments submitted to the Secretary be processed within certain time periods, and at least by the last day of the month following the month in which the enrollment or disenrollment was submitted; (4) provide for an annual audit to assure the timely processing of enrollment and disenrollment forms; and (5) prescribe standardized enrollment and disenrollment forms. Requires CMPs and HMOs to: (1) notify an individual who enrolls or disenrolls of the effective date of such enrollment or disenrollment; and (2) in the case of an individual's enrollment, supply the individual with a guide explaining the rules and procedures of the organization. Provides that in the case of an individual: (1) who enrolls with an HMO or CMP and who is an inpatient of a hospital on the date the enrollment would otherwise become effective, the enrollment shall not become effective until the day after discharge; and (2) who disenrolls and who is an inpatient on the date the disenrollment would otherwise become effective, the disenrollment shall not become effective until the day after discharge. Directs the Administrator of the Health Care Financing Administration, with respect CMPs and HMOs, to conduct a certain study and report to the Congress.

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1 official file

• Introduced in House

  summary · EN · 26 July 1985

  Open at official source

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