[19970918]97-859_医疗保险：医疗保险+选择计划下向HMO和其他私人计划支付的款项.pdf

Risk HMOs have risk-sharing contracts with Medicare. These HMOs are paid a pre-1established per person amount (i.e., a capitated payment) by Medicare. They are fully at risk forproviding the basic Medicare benefit package to beneficiaries who enroll in the HMO. OtherHMOs, known as cost-contract HMOs, contract with Medicare to provide benefits, but are notat financial risk; Medicare pays the HMO the actual cost of providing care to beneficiaries. Inaddition, Medicare makes payments to health care prepayment plans that contract to provide PartB services only on a cost contract basis. The new payment method described in this report wouldapply to risk HMOs and other Medicare+Choice organizations including preferred providerorganizations, provider sponsored organizations, private fee-for-service plans andMedicare+Choice medical savings account (MSA) plans.AAPCCs were adjusted for category of eligibility for Medicare (e.g., age, disability, or end-2stage renal disease), age, gender, whether the beneficiary resided in an institution, working status,and coverage under Medicaid. Following common usage, the term AAPCC is used in theremainder of this report to represent the reduced payment am