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| Wilson & Domenici Urge N.M. HMOs To Expand Coverage to Seniors |
October 16, 2000 |
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| In a letter to the heads of the three Medicare Choice providers in New Mexico, the two legislators urge reversing a decision to abandon coverage for thousands of seniors
ALBUQUERQUE -- U.S. Congresswoman Heather Wilson and Senator Pete Domenici today encouraged three Medicare Choice providers in New Mexico to reverse their decision to end coverage to 15,000 seniors in New Mexico.
In light of recent assurances that Congress will significantly increase Medicare Choice reimbursement rates for New Mexico providers, Domenici and Wilson today asked Presbyterian Healthcare Services, Lovelace Health Systems and St. Joseph Healthcare to reconsider their July decision to end their participation in the federal Medicare-HMO program, largely based on unfair federal reimbursement rates.
However, the two New Mexico lawmakers last week succeeded in convincing congressional budget negotiators to increase the reimbursement rate for the Medicare Choice program in New Mexico from $430 to $525 in the greater Albuquerque area and from $415 to $475 in the rest of the state.
“As you know, this is a huge victory for seniors in New Mexico and quite frankly is more than we could have ever realistically hoped to achieve. We believe New Mexico’s seniors now have a great chance to keep the health care they have chosen,” the two legislators wrote in a letter to the CEO’s of the three companies.
“In light of this good news, we urge you to begin considering how this new reimbursement rate will allow your company to continue providing service to so many New Mexico seniors, who have come to rely on the added benefits the Medicare Choice program offers them. Specifically, we would like you to reconsider you decision to end service in some areas, and also consider whether or not this new rate will allow you to open enrollment to new patients,” they said.
In separate meetings with the CEO’s of the three health care plans this morning, Wilson briefed the executives on the details of the reimbursement rate increase and personally urged the providers to reconsider their decision to withdraw from the program. She also encouraged them to consider increasing some of the benefits they currently offer to seniors in New Mexico.
The Health Care Financing Administration (HCFA) this summer reported that nearly 1 million seniors could lose their Medicare Choice coverage by 2001, possibly forcing them to return to the traditional Medicare Fee-for-Service program. Over the past three years, more than 1.7 million seniors have already been forced out of Medicare Choice plans because of unfair reimbursement rates.
Of the at-risk seniors, an estimated 15,000 of the 45,000 New Mexico seniors enrolled in Medicare Choice programs could lose coverage. In July, Presbyterian Healthcare Services and Lovelace Health Systems announced they would no longer be participating in the Medicare Chopice program outside of the greater Albuquerque area. And St. Joseph Healthcare in New Mexico informed HCFA of their intention to withdraw from the Medicare Choice program.
Under HCFA’s administration, reimbursement rates around the country have varied widely, with private health maintenance organizations dropping out of the Medicare Choice program in communities where reimbursement rates are lowest. For example, while patient care reimbursement rates are now $814 for Staten Island and $794 for Dade County, Fla., they are only $430 for Albuquerque and $453 for Portland, Ore., for the same senior services.
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