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 Collection: Congressional Research Service Reports
Medicaid Reimbursement Policy

Medicaid Reimbursement Policy

Date: November 2, 2004
Creator: Merlis, Mark
Description: This report begins with a summary of basic federal requirements applicable to payments for all services and an overview of major developments in federal Medicaid reimbursement policy over the last 20 years. This overview provides a historical context for current policies and highlights some issues that have been perennial concerns for federal and state policymakers. The next four sections of the report provide a detailed discussion of Medicaid reimbursement for four basic categories of services or providers.
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Medicaid, SCHIP, and Other Health Provisions in H.R. 5661: Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000

Medicaid, SCHIP, and Other Health Provisions in H.R. 5661: Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000

Date: January 4, 2001
Creator: Hearne, Jean P; Herz, Elicia J & Baumrucker, Evelyne P
Description: This report discusses Medicaid and the State Children’s Health Insurance Program (SCHIP). The report also discusses other major health provisions provisions of H.R. 5661 are incorporated, by reference into H.R. 4577, the Consolidated Appropriations Act 2001.
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Medicare Advantage

Medicare Advantage

Date: March 3, 2009
Creator: Morgan, Paulette C.
Description: This report is an overview of the Medicare Advantage (MA) program, an alternative way for Medicare beneficiaries to receive covered benefits, and includes legislative history and analysis of recent trends.
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Medicare Beneficiary Access to Care: The Effects of New Prospective Payment Systems on Outpatient Hospital Care, Home Health Care, and Skilled Nursing Facility Care

Medicare Beneficiary Access to Care: The Effects of New Prospective Payment Systems on Outpatient Hospital Care, Home Health Care, and Skilled Nursing Facility Care

Date: February 2, 2000
Creator: Merck, Carolyn L
Description: This report discusses the Balanced Budget Act of 1997 (BBA 97), which required that prospective payment systems replace retrospective cost-based reimbursement systems for Medicare beneficiaries receiving care in hospital outpatient departments, from home health care agencies, and in skilled nursing facilities.
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Medicare: Beneficiary Cost-Sharing Under Prescription Drug Legislation

Medicare: Beneficiary Cost-Sharing Under Prescription Drug Legislation

Date: July 25, 2003
Creator: Peterson, Chris L
Description: This report provides an analysis of how the cost-sharing and premium provisions under the Prescription Drug and Medicare Improvement Act of 2003 (S. 1) and the Medicare Prescription Drug and Modernization Act of 2003 (H bill would affect the amount that a beneficiary would pay annually for prescription drugs.
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Medicare: Beneficiary Cost-Sharing Under Proposed Prescription Drug Benefits

Medicare: Beneficiary Cost-Sharing Under Proposed Prescription Drug Benefits

Date: June 26, 2003
Creator: Peterson, Chris L
Description: This report provides background on how the cost-sharing and premium provisions under each bill would affect the amount that a beneficiary pays annually for prescription drugs. In addition, this report gives examples of how annual cost-sharing would differ for beneficiaries with various levels of total prescription drug spending in 2006 under the plans.
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Medicare: Beneficiary Cost-Sharing Under Proposed Prescription Drug Benefits

Medicare: Beneficiary Cost-Sharing Under Proposed Prescription Drug Benefits

Date: June 17, 2003
Creator: Peterson, Chris L
Description: This report examines these proposals as well as the “Medicare Rx Drug Benefit and Discount Act of 2003,” which was introduced by Representative Charles Rangel, the ranking member of the House Ways and Means Committee. Specifically, this report provides background on how the cost-sharing and premium provisions under each bill would affect the amount that a beneficiary pays annually for prescription drugs.
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Medicare: Changes to Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) Provisions

Medicare: Changes to Balanced Budget Act of 1997 (BBA 97, P.L. 105-33) Provisions

Date: November 19, 1999
Creator: O'Sullivan, Jennifer; Merck, Carolyn L; Smith, Madeleine T & Tilson, Sibyl L
Description: This report summarizes the major provisions of the agreement between the by House and Senate negotiators on the Medicare provisions.
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Medicare+Choice Payments

Medicare+Choice Payments

Date: January 22, 2003
Creator: Chaikind, Hinda Ripps & Morgan, Paulette C
Description: This report discusses the M+C program that established new rules for beneficiary and plan participation. This report focuses on M+C payments.
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Medicare+Choice Payments

Medicare+Choice Payments

Date: May 8, 2002
Creator: Chaikind, Hinda Ripps & Morgan, Paulette C
Description: This report discusses the M+C program that established new rules for beneficiary and plan participation. This report focuses on M+C payments.
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Medicare Endorsed Prescription Drug Discount Card Program

Medicare Endorsed Prescription Drug Discount Card Program

Date: August 19, 2004
Creator: O'Sullivan, Jennifer
Description: None
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Medicare Expansion: President Clinton's Proposals to Allow Coverage Before Age 65

Medicare Expansion: President Clinton's Proposals to Allow Coverage Before Age 65

Date: March 31, 1998
Creator: Lyke, Bob; Fuchs, Beth C; O'Sullivan, Jennifer & Smith, Madeleine T
Description: This report discusses medicare expansion; President Clinton's proposal to allow people ages 62 through 64 to buy into Medicare if they do not have access to employer-sponsored or federal health insurance.
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Medicare: Financing the Part A Hospital Insurance Program

Medicare: Financing the Part A Hospital Insurance Program

Date: April 11, 2005
Creator: O'Sullivan, Jennifer
Description: None
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Medicare: Financing the Part A Hospital Insurance Program

Medicare: Financing the Part A Hospital Insurance Program

Date: May 5, 1998
Creator: O'Sullivan, Jennifer
Description: This report discusses Medicare, which consists of two distinct parts — Part A (Hospital Insurance (HI)) and Part B (Supplementary Medical Insurance (SMI)). Part A is financed primarily through payroll taxes levied on current workers and their employers. Income from these taxes is credited to the HI trust fund. Part B is financed through a combination of monthly premiums paid by current enrollees and general revenues. Income from these sources is credited to the SMI trust fund.
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Medicare Home Health Benefit Primer: Benefit Basics and Issues

Medicare Home Health Benefit Primer: Benefit Basics and Issues

Date: March 14, 2013
Creator: Talaga, Scott R.
Description: This report describes home health eligibility criteria, home health services, characteristics of Medicare beneficiaries who use home health services, and home health providers. Further, this report describes in detail the Medicare home health prospective payment system (HH PPS), provides an overview of Medicare home health payments, and discusses issues for Congress related to the Medicare home health benefit.
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Medicare Home Health Benefit Primer: Benefit Basics and Issues

Medicare Home Health Benefit Primer: Benefit Basics and Issues

Date: February 6, 2014
Creator: Talaga, Scott R.
Description: This report describes home health eligibility criteria, home health services, characteristics of Medicare beneficiaries who use home health services, and home health providers. Further, this report describes in detail the Medicare home health prospective payment system (HH PPS), provides an overview of Medicare home health payments, and discusses issues for Congress related to the Medicare home health benefit.
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Medicare: Major Prescription Drug Provisions of Selected Bills

Medicare: Major Prescription Drug Provisions of Selected Bills

Date: July 10, 2002
Creator: O'Sullivan, Jennifer
Description: None
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Medicare: Major Prescription Drug Provisions of Selected Bills

Medicare: Major Prescription Drug Provisions of Selected Bills

Date: July 16, 2002
Creator: O'Sullivan, Jennifer
Description: None
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Medicare: Major Prescription Drug Provisions of Selected Bills

Medicare: Major Prescription Drug Provisions of Selected Bills

Date: August 14, 2002
Creator: O'Sullivan, Jennifer
Description: None
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Medicare/Medicaid Reimbursement: Selected References

Medicare/Medicaid Reimbursement: Selected References

Date: August 1, 1984
Creator: Shirley-Reynolds, Saundra
Description: This report is a compilation of selected articles, books, and executive agency and congressional publications on Medicare and Medicaid reimbursement, primarily to health facilities and physicians.
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Medicare: Part B Premium Penalty

Medicare: Part B Premium Penalty

Date: June 29, 2005
Creator: O'Sullivan, Jennifer
Description: None
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Medicare Payment Policies

Medicare Payment Policies

Date: February 23, 2005
Creator: Tilson, Sibyl L; Chaikind, Hinda Ripps; O'Sullivan, Jennifer; Morgan, Paulette C; Justice, Diane; Stone-Axelrad, Julie et al.
Description: None
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Medicare: Payments to HMOs and Other Private Plans Under the Medicare+Choice Program

Medicare: Payments to HMOs and Other Private Plans Under the Medicare+Choice Program

Date: September 18, 1997
Creator: Smith, Madeleine T
Description: This report describes how payments will be calculated under the Medicare+Choice program established under the new law.
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Medicare: Payments to Physicians

Medicare: Payments to Physicians

Date: January 28, 1998
Creator: O'Sullivan, Jennifer
Description: This report discusses payments for physicians services under Medicare that are made on the basis of a fee schedule.
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