260. Medicare

260.994 Medicaid/Medicare Parity in Reimbursement Rates

 

If the state of Colorado elects to receive federal dollars to expand its Medicaid program under the Affordable Care Act, the Colorado Medical Society supports the rapid enactment of parity between Medicare and Medicaid physician reimbursement that encourages physician participation. Co-located as 260.994.
(LATE RES 8-P, AM 2012; Reaffirmed, BOD-1, AM 2014)

260.995 Analysis of Individual Procedures for Payment Reduction

 

The Colorado Medical Society (CMS) encourages the Centers for Medicare and Medicaid Services to conduct a thorough analysis of data prior to the implementation of any multiple procedure percentage reduction (MPPR) into the Medicare program to determine what efficiencies actually exist. CMS believes that the best avenue for this analysis and recommendation is done at the individual procedure/service level through the existing AMA RUC process.
(Reaffirmed, BOD-1, AM 2014)

260.996 Correction of Medicare Under-reimbursement to Colorado Physicians

 

The Colorado Medical Society (CMS) continues to support our AMA delegation encouraging our congressional delegation to introduce and support legislation that would remedy the Medicare’s Geographic Practice Cost Indices (GPCI) adjustment for Colorado, so that Medicare reimbursement to Colorado physicians becomes comparable to the reimbursement in regions with similar costs of living. The CMS shall continue to work with the Governor and other state officials to document the impact of low Medicare reimbursement on Colorado and encourage the Centers for Medicare and Medicaid Services to support legislation to remedy the current inequities.
(Revised Late RES-28, AM 2002; Revised, BOD-1, AM 2014)

260.997 Terminating Participation in Medicare - Managed Care Plans’ Responsibility to Patients

 

While the Colorado Medical Society (CMS) recognizes the managed care plan’s right to make business decisions, they are responsible for assuring their enrollees receive the health care needed with a minimal amount of disruption. It is ultimately the responsibility of the HMO to help minimize the financial impact to the patient and to assist in the transition of care.

The CMS encourages any managed care organization terminating a particular line of business or terminating a particular group of insureds to:

• Establish education sessions for enrollees outlining options available to them and steps to be taken to review those options;
• Develop a list of resources available to assist patients, such as government agencies, consultants etc.; and
• Implement the CMS/Colorado Association of Health Plan’s “Recommended Elements of Transition of Care”.

Additional Information: Recommendations for Transition of Care

(RES-15, AM 1999; Reaffirmed, BOD-1, AM 2014)

260.998 Medicare Changes to Ensure Patients’ Access to Physicians

 

The Colorado Medical Society encourages the federal Congressional Delegation and their health advisors, to affect changes that would encourage doctors to continue to see Medicare patients. Some suggested changes are: reduction of the massive paperwork, difficulty in obtaining ancillary services, and hassles inherent in the threat of fraud charges.
(RES-23, AM 1999; Reaffirmed, BOD-1, AM 2014)

260.999 Control of Medicare Spending Growth

 

The Colorado Medical Society opposes the use of Expenditure Targets/Sustained Growth Rate to control the volume of services rendered to Medicare beneficiaries and supports a more appropriate approach through funding research on the effectiveness of medical interventions to determine the effect on their outcomes, or the use of accountable focused peer review to examine the variant utilization patterns of Medicare Part B providers. These recommendations take into account the variables of new technologies and other factors that contribute to increased volume.
(RES-50, AM 1989, and RES-22, AM 1988; Reaffirmed, BOD-1, AM 2014)