Determine psychiatric inpatient days per 1,000 enrollees
The results of this enrollee
survey, however, do not support the original hypothesis that university clinics attract sicker patients whose care increases the economic risks to clinics caring for them under a prepaid capitated plan.
To help coverage issuers protect themselves from taking on more than their fair share of enrollee
health risk, the ACA drafts created the risk-adjustment program.
The two risk reimbursement proposals might be less visible to the high-risk enrollees
, offer the high-risk enrollees
better benefits and care management services, and be easier to administer, the analysts write.
When GAO analysts looked at the enrollees
, they found that 29% were in plans in the good-health group, 55% in plans in the average-health group, and 16% in plans in the poor-health group.
With few exceptions, notably age and state of residence, children in the established enrollee
sample closely resemble the children in the recent enrollee
sample (Table 1).
There is a clear need to develop better estimates of dual (Medicare and Medicaid) enrollees
and the subpopulation of dual enrollees
who receive full Medicaid benefits.
get Medicare coverage from two separate programs: the Medicare Part A hospitalization program, which has a deductible of $1,316 per inpatient deductible, and the Part B outpatient physician services program, which has a $183 annual deductible.
CMS is also finalizing policies that will further combat opioid overutilization by encouraging safeguards before an opioid prescription is dispensed at the pharmacy, while preserving flexibility that will maintain access to needed medications for Medicare enrollees
in the Part D prescription drug benefit.
This paper answers three specific research questions: What type of health insurance coverage, if any, did HIFA enrollees
report just prior to enrollment in the HIFA program?
For a new enrollee
with family income near the poverty level, this may be significant if the child has no immediate need for health care.
In 2016, HHS plans to start publishing the enrollee
survey results itself.