Tenet Choices 65's Adjusted Community Rate Proposal Modifications for Contract Year 2004

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Peoples Health Network's (Peoples Health) use of its payment increase was adequately supported and allowable in accordance with the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). Peoples Health's use of its MMA payment increase was adequately supported and allowable under the MMA. Peoples Health appropriately used the increased Medicare capitation payments to reduce beneficiary cost sharing, enhance benefits, and stabilize beneficiary access to providers. Specifically, Peoples Health eliminated physical therapy and vision hardware copayments, reduced copayments on prescription drugs, waived member enrollment fees for the prescription drug discount card, and increased the percentage of premiums passed through to providers.