HHS: Carriers Can Team Up

March 21, 2005 at 07:00 PM
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Federal officials say single-state health insurers can form alliances to compete for Medicare managed care and Medicare drug benefit plan contracts.[@@]

The U.S. Department of Health and Human Services has issued a pair of final rules stating that several health plans can unite to form a "joint enterprise" that can enter into contracts to offer a single prescription drug plan or a single Medicare Advantage managed care plan in a multistate region.

Several health plans have asked about the possibility of forming regional alliances, according to the rulings, which were issued by Mark McClellan, administrator for the Centers for Medicare & Medicaid Services, and HHS Secretary Michael Leavitt.

"The statute generally requires that the [contracting] ?entity' be licensed by the state as a risk-bearing entity where it offers benefits," officials write in a preamble to the rulings, which appear today in the Federal Register.

A joint enterprise could be treated as a single entity for purposes of offering a prescription drug plan or a Medicare Advantage plan "as long as the enterprise as a whole meets all applicable Medicare requirements, and there is no substantive difference between this arrangement and a traditional entity from a Medicare enrollee's perspective," officials write.

A joint enterprise must serve the entire region that it asks to serve and use a single name throughout the entire region, officials write.

A joint enterprise also must "provide uniform enrollee customer service and appeal and grievance rights throughout the region," officials write.

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