Centers for Medicare and Medicaid Services Paid Medicare Advantage Organizations for Services Provided to Beneficiaries Confined in Mental Health Facilities for Court-Ordered Purposes.

摘要

While performing a separate review of Medicare Part D prescription drug payments made on behalf of beneficiaries incarcerated in correctional facilities (incarcerated beneficiaries), we observed that although Part C (i.e., Medicare Advantage (MA)) and Part D requirements generally prohibit benefits paid on behalf of incarcerated beneficiaries, the requirements allow benefits paid on behalf of beneficiaries confined in mental health facilities (State hospitals, Institutions for Mental Diseases, psychiatric hospitals, or hospital psychiatric units) by court order under a penal code. (We refer to these individuals as confined beneficiaries.) In contrast, Medicares traditional fee-for-service (FFS) program (Part A and Part B) generally does not pay benefits on behalf of incarcerated or confined beneficiaries. Because of this inconsistent policy, we evaluated the impact on MA of paying for services provided to confined beneficiaries. The objective of this review was to evaluate the impact of the payments that the Centers for Medicare & Medicaid Services (CMS) made to MA organizations on behalf of confined beneficiaries during calendar years (CYs) 2011 and 2012.