Benefits and Beneficiary Protections398
A Medicare + Choice organization may not deny, limit or condition coverage or provision of benefits for individuals based on any health status-related factor described in § 2702(a)(1) of the Public Health Service Act.399
Each Medicare Advantage organization shall have an ongoing quality improvement program for the purpose of improving the quality of care provided to enrollees in each Medicare Advantage plan.400 As part of this quality improvement program, each Medicare Advantage organization will have a chronic care improvement program; such program will have a method for monitoring and identifying enrollees with multiple or sufficiently severe chronic conditions.401 Also as part of this program, each Medicare Advantage organization will provide for the collection, analysis and reporting of data that permits the measurement of health outcomes and other indices of quality.402
The Secretary shall biennially submit to Congress a report regarding how quality assurance programs focus on racial and ethnic minorities.403 Each report will include an evaluation of the impact of such programs on eliminating health disparities and on improving health outcomes, continuity and coordination of care, management of chronic conditions and consumer satisfaction,404 as well as recommendations on ways to reduce clinical outcome disparities among racial and ethnic minorities.405
Each Medicare + Choice organization must provide meaningful procedures for hearing and resolving grievances between the organization and enrollees with Medicare+Choice plans.406
To the extent that a Medicare+Choice organization maintains medical records or other health information regarding enrollees, the organization will establish procedures to safeguard the privacy of any individually identifiable enrollee information407 and to assure timely access of enrollees to such records and information.408
Footnotes
- 398. Social Security Act § 1852, 42 U.S.C. 1395w-22.
- 399. Social Security Act § 1852(b)(1)(A), 42 U.S.C. 1395w-22(b)(1)(A).
- 400. Social Security Act § 1852(e)(1), 42 U.S.C. 1395w-22(e)(1).
- 401. Social Security Act § 1852(e)(2), 42 U.S.C. 1395w-22(e)(2).
- 402. Social Security Act § 1852(e)(3), 42 U.S.C. 1395w-22(e)(3).
- 403. Social Security Act § 1852(e)(5)(A), 42 U.S.C. 1395w-22(e)(5)(A).
- 404. Social Security Act § 1852(e)(5)(B)(ii), 42 U.S.C. 1395w-22(e)(5)(B)(ii).
- 405. Social Security Act §1852(e)(5)(B)(iii), 42 U.S.C. 1395w-22(e)(5)(B)(iii).
- 406. Social Security Act § 1852(f), 42 U.S.C. 1395w-22(f).
- 407. Social Security Act § 1852(h)(1), 42 U.S.C. 1395w-22(h)(1).
- 408. Social Security Act § 1852(h)(3), 42 U.S.C. 1395w-22(h)(3).
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