Review of Medicare Prescription Drug, Improvement, and Modernization Act Modifications to Calendar Year 2004 Proposal - Horizon Healthcare of New Jersey, Inc.

EXECUTIVE SUMMARY :

The objective of our review was to determine whether Horizon Healthcare of New Jersey, Inc.'s (Horizon's) use of its MMA payment increase was adequately supported and allowable under MMA.  Horizon's use of its MMA payment increase was adequately supported and allowable under the MMA.  Horizon appropriately used the increased Medicare capitation payments to reduce beneficiary premiums, enhance benefits, and stabilize and enhance beneficiary access to providers.  Specifically, Horizon eliminated beneficiary premiums, enhanced benefits by adding vision and prescription benefits, and increased capitation payments to primary care providers.  Therefore, we did not make any recommendations.