Medicare Managed Care Provisions of Title II of S. 1, as Passed by the Senate, and H.R. 1, as Passed by the House

Publication Date: August 2003

Publisher: Library of Congress. Congressional Research Service

Author(s):

Research Area: Health

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Abstract:

On June 27, 2003, the Senate passed the Prescription Drug and Medicare Improvement Act of 2003 (S. 1) and the House passed the Medicare Prescription Drug and Modernization Act of 2003 (H.R. 1).

Title II of each bill would establish a new Medicare managed care program to replace the current Medicare+Choice program. Under S. 1, Title II would establish the MedicareAdvantage (MA) program to replace the M+C program. The MA program would continue to offer coordinated care and other plans on a county-wide basis as under current law. The bill would also establish regional Preferred Provider Organizations (PPOs), to be offered in regions. Beginning in 2008, the bill would establish a limited competition program, in designated highly competitive areas. Under H.R. 1, Title II would establish the Medicare Advantage (MA) program to replace the M+C program, which would also continue to offer coordinated care and other plans on a county-wide basis as under current law. The bill would establish the Medicare Enhanced Fee-for-Service (EFFS) program, under which Medicare beneficiaries would be provided access to a range of regional EFFS plans that could include preferred provider networks. Beginning in 2010, it would also use competitive bidding, in the same style of the Federal Employees Health Benefits program (FEHBP) for certain EFFS plans and MA plans.

There are considerable differences in the specifics of the MA provisions in S. 1 and H.R. 1. These differences are at issue in a pending conference between the two Houses.

This report provides a side-by-side comparison of the Title II provisions of both bills, and will be updated as necessary.