Congressman Bill Thomas (R-CA), Chairman, Subcommittee on Health of the Committee on Ways and Means, today announced that the Subcommittee will hold a hearing on Medicare provider sponsored organizations. The hearing will take place on Thursday, April 24, 1997, in room 1310 Longworth House Office Building, beginning at 1:00 p.m.
In view of the limited time available to hear witnesses, oral testimony at this hearing will be from invited witnesses only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing.
BACKGROUND:
Provider-sponsored organizations were a key component included in the Balanced Budget Act of 1995 (which was vetoed by the President) to increase the array of private plan choices available to Medicare beneficiaries. President Clinton also included a PSO initiative in his Fiscal Year 1998 budget proposal. Under current law, the only types of managed-care organizations qualified to participate in Medicare are Federally-qualified health maintenance organizations (HMOs) and State-approved competitive medical plans. HMOs and competitive medical plans are required by Medicare law, among other things, to be licensed under the laws of a State as a condition of participating in Medicare, and many states require PSOs to meet the same licensing and operating requirements as HMOs.
PSOs generally are cooperative ventures of hospitals and groups of physicians that eliminate the health insurer or managed-care plan as an intermediary and offer health services and insurance coverage directly to patients.
While there is now a growing consensus that PSOs should be allowed as a new option for Medicare beneficiaries, the conditions under which PSOs will be allowed to participate in the Medicare program have been subject to considerable debate.
Under the Balanced Budget Act of 1995, PSOs were defined broadly as public or private entities established or organized by health care providers or groups of affiliated providers. The Balanced Budget Act generally required affiliated providers to assume full financial risk on a prospective basis for all Medicare benefits, and allowed PSOs to meet Federal solvency and capital standards developed under a negotiated rulemaking process. PSOs could seek temporary waivers of State laws, other than for solvency, under certain circumstances.
The President's PSO proposal would require PSOs to be affiliated with hospitals, require PSOs to assume substantial financial risk only under certain circumstances, and preempt State solvency laws that differ from Federal PSO solvency standards. The President's proposal would require State licensure of PSOs where State standards are substantially equivalent or, after 1999, more stringent than the Federal Government's PSO licensing requirements. Both the Balanced Budget Act and the President's proposal would reduce for PSOs the minimum number of enrollees necessary to participate in the Medicare program and waive the requirement under certain circumstances that PSOs have 50-percent non-Medicare and non-Medicaid enrollees. Several separate bills also have been introduced in the 105th Congress by Members of both parties in the House and Senate to make PSOs available under the Medicare program.
In announcing the hearing, Chairman Thomas stated: "Expanding choice by allowing beneficiaries to enroll in provider-sponsored organizations and other private health plans was a key point of the Republican Medicare restructuring plan in the 104th Congress. I am pleased that the President has now joined us in the growing consensus to give seniors more choice. Because the health care market is constantly changing, however, we need to examine more closely the proper role of the Federal government and standards of participation for PSOs in the Medicare program. I believe doctors and hospitals ought to have the right incentives to join together to offer their own health plans to Medicare beneficiaries."
FOCUS OF THE HEARING:
The hearing will focus on the role that PSOs may play in offering expanded private coverage options to Medicare beneficiaries and the standards of participation under which PSOs are most likely to optimize benefits to beneficiaries.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Any person or organization wishing to submit a written statement for the printed record of the hearing should submit at least six (6) copies of their statement and a 3.5-inch diskette in WordPerfect or ASCII format, with their address and date of hearing noted, by the close of business, Thursday, May 8, 1997, to A.L. Singleton, Chief of Staff, Committee on Ways and Means, U.S. House of Representatives, 1102 Longworth House Office Building, Washington, D.C. 20515. If those filing written statements wish to have their statements distributed to the press and interested public at the hearing, they may deliver 200 additional copies for this purpose to the Subcommittee on Health office, room 1136 Longworth House Office Building, at least one hour before the hearing begins.
FORMATTING REQUIREMENTS:
Each statement presented for printing to the Committee by a witness, any written statement or exhibit submitted for the printed record or any written comments in response to a request for written comments must conform to the guidelines listed below. Any statement or exhibit not in compliance with these guidelines will not be printed, but will be maintained in the Committee files for review and use by the Committee.
1. All statements and any accompanying exhibits for printing must be typed in single space on legal-size paper and may not exceed a total of 10 pages including attachments. At the same time written statements are submitted to the Committee, witnesses are now requested to submit their statements on a 3.5-inch diskette in WordPerfect or ASCII format.
2. Copies of whole documents submitted as exhibit material will not be accepted for printing. Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material not meeting these specifications will be maintained in the Committee files for review and use by the Committee.
3. A witness appearing at a public hearing, or submitting a statement for the record of a public hearing, or submitting written comments in response to a published request for comments by the Committee, must include on his statement or submission a list of all clients, persons, or organizations on whose behalf the witness appears.
4. A supplemental sheet must accompany each statement listing the name, full address, a telephone number where the witness or the designated representative may be reached and a topical outline or summary of the comments and recommendations in the full statement. This supplemental sheet will not be included in the printed record.
The above restrictions and limitations apply only to material being submitted for printing. Statements and exhibits or supplementary material submitted solely for distribution to the Members, the press and the public during the course of a public hearing may be submitted in other forms.
The
Committee seeks to make its facilities accessible to persons with
disabilities. If you are in need of special accommodations, please
call 202-225-1721 or 202-225-1904 TTD/TTY in advance of the event
(four business days notice is requested). Questions with regard to
special accommodation needs in general (including availability of
Committee materials in alternative formats) may be directed to the
Committee as noted above.