About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

Estimate of the Administration's Proposal to Limit Enrollment in the Uniformed Services Family Health Plan 1 (April 2011)

handle is hein.congrec/cbo8022 and id is 1 raw text is: April 29, 2011 Estimate of the Administration's Proposal to Limit Enrollment in the Uniformed Services Family Health Plan The Administration's budget request for fiscal year 2012 includes a proposal to begin limiting enrollment in the Uniformed Services Family Health Plan (USFHP). CBO's analysis indicates that because of uncertainty about the process used to determine the payment rates, providing health care through the USFHP probably costs the government more than providing that care though other federal health programs. CBO estimates that enacting the proposal would reduce federal direct spending by $104 million over the 2012-2021 period. An explanation of that estimate is provided below. Background The Uniformed Services Family Health Plan is an association of six nonprofit Health Maintenance Organizations that took ownership and control of Public Health Service hospitals in the early 1980s. By law, the Department of Defense (DoD) is required to enter into agreements with those entities to provide care to beneficiaries of the military health system (10 U.S.C. 1073 note). Beneficiaries who live in a location served by one of the six HMOs may elect to discontinue their regular TRICARE or Medicare coverage and instead enroll in USFHP. (TRICARE is the military's health care program.) Currently about 110,000 individuals are enrolled in USFHP plans; most of those individuals are military retirees or dependents of retirees, and about 40,000 are Medicare- eligible. CBO estimates that DoD's payments to USFHP plans will total about $1.1 billion in 2011. Of that amount, about $720 million will be for Medicare-eligible beneficiaries. Per capita payments for Medicare-eligible beneficiaries are paid from the Department of Defense Medicare-Eligible Retiree Health Care Fund (MERHCF) and are considered mandatory. For those enrolled in USFHP, there are no reimbursements or cost sharing by Medicare. Payments to the USFHP entities are made on a fixed per capita basis. The plans receive a fixed dollar amount for each individual enrolled in their plan, with appropriate adjustments for age, gender, and geographic price differences. Once the payments are made, the USFHP plans assume all risk for the health care costs incurred by enrolled individuals. By law, the payments are supposed to reflect the actual historical cost to the USFHP plans of providing care to the enrolled beneficiaries (also referred to as the experience rate). However, the payments are not supposed to exceed the cost that would have been incurred by the federal government if those enrollees had received their

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most