Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of the Benefits Improvement Protection Act (BIPA) Modifications to Mercy Health Plans' St. Louis, Missouri Calendar Year 2001 Adjusted Community Rate Proposal Under Contract Number H-2667, Plan Numbers 001, 003, 004, 005 and 006," (A-07-04-01001)

March 2, 2004


Complete Text of Report is available in PDF format (187 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objectives of this review were to determine whether Mercy Health Plansí (Mercy) modifications to the contract year 2001 Adjusted Community Rate Proposal (proposal), submitted under the Benefits Improvement Protection Act (BIPA) of 2000, were supported and whether additional capitation payments were used in a manner consistent with the BIPA requirements.  Our review determined that Mercy adequately supported modifications to the calendar year 2001 proposal.  The review also confirmed that Mercy utilized the increased payments in accordance with BIPA requirements and as stated in their proposals.  The increased BIPA payments were in fact used to reduce beneficiary premiums and cost sharing, and for increased payments to stabilize provider networks.