Question

An agreement between the HMO and CMS to provide services to Medicare beneficiaries under which the health plan receives a monthly payment for enrolled Medicare members and must then provide all services needed is called a(n) ______

a. Health Maintenance Agreement (HMA)
b. Managed Care Organization (MCO)
c. Accountable Care Organization (ACO)
d. Capitated Medicare Advantage Plan (CMAP)

Answer 1

The agreement in question is a Capitated Medicare Advantage Plan (CMAP), in which the HMO receives a monthly payment for each Medicare member enrolled and provides all necessary services, moving away from fee-for-service to reduce moral hazard.

Step-by-step explanation:

An agreement between the Health Maintenance Organization (HMO) and the Centers for Medicare & Medicaid Services (CMS) to provide services to Medicare beneficiaries, under which the health plan receives a monthly payment for enrolled Medicare members and must then provide all necessary services, is called a Capitated Medicare Advantage Plan (CMAP).

In this model, the HMO is reimbursed on a per member per month basis, which incentivizes the provision of care in a cost-effective manner. This shift from the traditional fee-for-service model to HMOs aims to reduce moral hazard by aligning the interests of healthcare providers with the cost-efficient delivery of healthcare services.