Health Maintenance Organizations Medicare Reimbursement Amendments of 1979 - Amends title XVIII (Medicare) of the Social Security Act to revise provisions relating to payments to and contractual arrangements with health maintenance organizations (HMO) on behalf of individuals eligible for Medicare. Directs the Secretary of Health, Education, and Welfare to determine annually a per capita rate of payment for each class of individuals entitled to benefits under such title who are enrolled pursuant to this Act with a HMO. Directs the Secretary to define classes of members based on such factors as age, sex, institutional status, disability status and place of residence. Provides a rate for each class equal to 95 percent of the adjusted average per capita cost for that class. Defines the term "adjusted average per capita cost" to mean the average per capita amount that the Secretary estimates would be payable for services furnished under the Medicare program, if the services were to be furnished by other than an HMO.
Provides that every individual entitled to benefits under parts A (Hospital Insurance) and B (Supplementary Medical Insurance) of title XVIII or part B only shall be eligible to enroll with an HMO with which the Secretary has contracted to provide services.
Sets limits on an HMO's premium rate and the actuarial value of its other charges for individuals enrolled under this Act.
Authorizes the Secretary to contract with any HMO that can provide the benefits required by this Act.
Introduced in Senate
Referred to Senate Committee on Finance.
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