Minnesota Senior Federation, Metropolitan Region Mary Sarno v. United States of America Tommy G. Thompson , Secretary of Health and Human Services

LOKEN, Circuit Judge.

The “Medicare q-Choice” program was enacted as part of the Balanced Budget Act of 1997 and is now codified at 42 U.S.C. §§ 1395w-21 to w-28. The program includes reimbursement provisions that encourage managed health care organizations to be cost-effective and to pass cost savings on to their members in the form of additional benefits or reduced charges. As under prior law, cost effec tiveness is measured by a formula based primarily on “fee-for-service” health care costs in each local community, an approach that results in substantial geographic variations. Though…