Medicare Beneficiary Protection Amendments of 1995

TABLE OF CONTENTS:

Title I: Protections for Beneficiaries Enrolled in Health

Maintenance Organizations

Subtitle A: Access to Services

Subtitle B: Protections Against Fraud and Abuse

Subtitle C: Effective Date

Title II: Protections for Beneficiaries Enrolled in Medicare

Supplemental and Medicare Select Policies

Title III: Coordination of Enrollment and Termination of

Enrollment

Medicare Beneficiary Protection Amendments of 1995 - Title I: Protections For Beneficiaries Enrolled In Health Maintenance Organizations - Subtitle A: Access to Services - Amends title XVIII (Medicare) of the Social Security Act (SSA) to establish various specified requirements for eligible organizations under provisions for payments to health maintenance organizations (HMOs) and competitive medical plans that, among other things, relate to: (1) contracting with health care providers; (2) utilization review programs; (3) access to designated centers of excellence; (4) referrals to gynecologists; (5) essential community provider networks; (6) access to emergency services; (7) appeal of plan denials; (8) service areas; (9) arrangements with providers of renal dialysis services to cover services furnished to enrollees temporarily outside the organization's service area; (10) expanded plan services; and (11) additional Federal payments for enrollee services.

(Sec. 107) Directs the Secretary of Health and Human Services to conduct a demonstration project on eligible organization competitive rate setting.

Subtitle B: Protections Against Fraud and Abuse - Revises fraud and abuse requirements with respect to: (1) imposing intermediate sanctions for contract and other violations by eligible organizations; (2) providing enrollees with information on physician incentive plans and provider credentials; (3) agent commissions; (4) enrollment; and (5) application of peer review to other types of organization contracts.

(Sec. 111) Directs the Secretary to develop a model of the agreement that an eligible organization with a risk-sharing contract must enter into with an entity providing peer review services with respect to organization services.

Directs the Comptroller General to study and report to the Congress on the costs incurred by eligible organizations of entering into such agreements.

(Sec. 112) Restricts to non-HMO type eligible organizations the types of organizations that can qualify for treatment as a health care prepaid plan (HCPP) under the program for supplementary medical insurance benefits for the aged and disabled.

Repeals provisions subjecting such prepaid plans to Medigap standards.

Subtitle C: Effective Date - Sets forth the effective date for this title.

Title II: Protections For Beneficiaries Enrolled In Medicare Supplemental and Medicare Select Policies - Amends SSA title XVIII to make various specified changes in requirements for Medicare supplemental policies, including requirements for community rating and prior approval of marketing materials, in addition to certain other requirements.

Title III: Coordination of Enrollment and Termination of Enrollment - Amends SSA title XVIII to establish uniform annual open enrollment periods for eligible organization, Medicare supplemental plan, and Medicare select plan enrollees generally, with certain exceptions, during which they can enroll, disenroll, or switch plans.

(Sec. 302) Sets forth special rules for enrollment in an eligible organization plan for new Medicare beneficiaries and those who move.

(Sec. 303) Directs the Secretary to provide information on Medicare supplemental policies and other specified matters to Medicare beneficiaries upon request.