Uncertainties Surround Proposal To Expand Prepaid Health Plan Contracting Gao ID: HRD-88-14 November 2, 1987

Pursuant to a congressional request, GAO reviewed a Department of Health and Human Services (HHS) proposal seeking legislative authority to contract with employer-based health plans to provide Medicare benefits to the employers' retirees.

GAO found that: (1) the proposed methods for reimbursing employer-based plans differ significantly from those HHS uses to reimburse risk-based health maintenance organizations; (2) HHS has had problems implementing prior capitation initiatives; (3) HHS should develop safeguards to ensure that payment rates do not result in overcompensating health service plans; and (4) HHS plans to research the proposed legislation's effect on existing Medicare prepaid plans.


Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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