New US Medicare Regs For HMOs

New US Medicare regulations announced by Health and Human ServicesSecretary Donna Shalala require health maintenance organizations that deny treatment to seniors with urgent health problems to respond within 72 hours, rather than the previous 60 days. The regulations affect the 13% of Medicare beneficiaries enrolled in HMOs.

Medicare HMOs must also accept verbal requests for appeals and follow up verbally-delivered notification of their decisions with a written notice within two working days. HMOs have 120 days to put the new procedures in place and tell Medicare patients of the change; they must maintain logs of and report requests for the expedited appeals to Medicare.

American Association of Health Plans officials said they had not seen the final regulations but had talked with the administration during their development. The administration is also working on a plan to reform the appeals process for Medicare HMO patients who are unhappy with their care but necessarily need urgent care.