Medicare:

Impact of State Mandatory Assignment Programs on Beneficiaries

HRD-89-128: Published: Sep 19, 1989. Publicly Released: Oct 20, 1989.

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Pursuant to a congressional request, GAO assessed the impact of four states' mandatory assignment laws, which required physicians to accept Medicare's approved amount as full payment for certain health care services, on: (1) Medicare beneficiaries' and non-beneficiaries' out-of-pocket costs; (2) physician services volume and intensity; and (3) Medicare beneficiaries' access to health care.

GAO found that: (1) Massachusetts' February 1986 law prohibited physicians from collecting balance bills, or the difference between the physician charge and the Medicare-approved amount, from any Medicare beneficiary; (2) Rhode Island's July 1987 law prohibited physicians from collecting balance bills from aged beneficiaries with incomes below a specified level; (3) Vermont's July 1987 law limited physicians' charging of balance bills to Medicare beneficiaries with incomes above a specified level or for office and home visits, regardless of beneficiaries' income; and (4) Connecticut's June 1987 law prohibited physicians from collecting balance bills from Medicare beneficiaries with incomes below a specified level and required beneficiaries to apply for coverage and submit proof of income. GAO also found that, although more time may be necessary to assess the full effects of the mandatory assignment legislation, data indicate that: (1) the laws resulted in increased assignment rates in all four states and reduced out-of-pocket costs for covered beneficiaries; (2) physicians did not offset the reduced income from covered Medicare beneficiaries by increasing non-covered beneficiaries' bills; (3) the volume and intensity of Medicare-covered physician services did not increase as a result of the legislation; and (4) the laws did not result in reduced access to health care.

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