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WASHINGTON, D.C. – Congresswoman Lois Capps stepped up her efforts to protect health care coverage for Central Coast seniors by delivering a timely report to Donna Shalala, Secretary of Health and Human Services and requesting an immediate review of Medicare reimbursement rates for Santa Barbara and San Luis Obispo Counties.
The report was issued by Cottage Hospital of Santa Barbara and is being circulated among local health care providers. It alleges that a series of miscalculations resulted in extremely low Medicare reimbursement rates for Santa Barbara County. “The data from this comprehensive study indicates that Central Coast HMOs are being shortchanged,” charged Capps. “And this low reimbursement rate is one of the primary reasons why HMOs are leaving Medicare -- and leaving seniors out in the cold,” she added.
In recent weeks, several managed care companies have announced that they will withdraw their Medicare HMOs for seniors living in San Luis Obispo County. Rep. Capps responded to this crisis by introducing the Medicare Beneficiary Emergency Relief Act, which would extend the contracts of these HMOs for six months, ensuring seniors access to health care while Congress works out a permanent solution. Capps also coauthored the Medicare Health Plan Fair Payment Act, which would increase the Medicare HMO reimbursement in rural areas.
The reimbursement issue is at the heart of the Cottage Hospital report. “This painstaking report reviews each step taken to arrive at the current reimbursement rate and reveals that critical errors beginning in 1994 resulted in today’s unacceptably low figure,” Capps announced. According to the report, Santa Barbara County HMOs should be receiving $507.62 per member per month, a significant increase from the current $390. “Fixing this formula is a critical step in preventing this crisis from spreading to Santa Barbara County seniors,” Capps stated.
Capps announced that she directed her staff to hand deliver the study to Secretary Shalala. “Armed with this new information, the Secretary should conduct an immediate review of the Medicare HMO reimbursement rates on the Central Coast so that we can stop the bleeding in our senior health care system,” Capps stated.
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Pictured above: (center) Congresswoman Capps meets with Central Coast firefighters to discuss emergency preparedness.
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