In order to encourage plans to stay in their service areas and in the Medicare program, the legislation strengthens the Secretary's enforcement authority by increasing the civil monetary penalties that the Secretary may assess on plans that violate their contracts. Codifies risk adjustment phase-in for managed care plans . The BBA required that payments to managed care plans be risk adjusted, to prevent adverse selection and to encourage plans to enroll sicker beneficiaries. Changes provider participation rules and quality standards . Medicare reimbursement for hospices has not risen at the same rate as hospice costs.
Hospices now provide more expensive services and serve sicker patients.
Raises payments for renal dialysis . Prior to the BBRA, Medicare's payments for dialysis hadve not increased since 1991. Adjusts updates for durable medical equipment, orthotics and prosthetics, and ambulances . The legislation directs the Secretary of Health and Human Services to finalize the regulation eliminating a reimbursement loophole that threatens the fiscal integrity of the Medicaid program. The legislation also provides for a six-year transition period for those states with payment arrangements in effect in 1992 that may violate the new regulation.