GAO – Page 2 – DeBrunner & Associates

GAO Looks at Medicaid Managed Care Spending

The federal government should do more to help states ensure the accuracy and integrity of their payments to Medicaid managed care organizations and the payments those Medicaid managed care organizations make to health care providers. This is the conclusion reached in a new study of Medicaid managed care performed by the U.S. Government Accountability Office at the request of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs. The GAO study identified six payment risks among various transactions between state governments, Medicaid managed care organizations, and health care providers. The two biggest risks, the [...]

iqtsupport2018-07-31T10:00:57-04:00July 31, 2018|Medicaid managed care|

GAO: CMS Needs to Do Better Job on Demonstration Evaluations

The federal government needs to do a better job of evaluating Medicaid demonstration programs, according to the U.S. Government Accountability Office. Demonstration programs, on which the federal government spends more than $300 billion a year, exempt states from selected federal Medicaid requirements and regulations so they can test new approaches to providing and paying for care for their Medicaid population. As part of waiving these requirements, the Centers for Medicare & Medicaid Services requires the states to perform or commission evaluations of the effectiveness of those new approaches. According to a new GAO study, however, those reports are not always [...]

iqtsupport2018-02-22T06:00:25-05:00February 22, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Conflicts of Interest Mar HCBS

States’ efforts to provide home- and community-based services to elderly and disabled Medicaid beneficiaries who need assistance to continue living independently continue to be plagued with conflicts of interest that the Centers for Medicare & Medicaid Services is not adequately addressing. Or so concludes a new study published by the U.S. Government Accountability Office. According to the GAO, …conflict of interest remain in regard to HCBS providers and managed care plans. HCBS providers may have a financial interest in the outcome of needs assessments, which could lead to overstating needs and overprovision of services. CMS has addressed risks associated with [...]

iqtsupport2018-01-22T06:00:23-05:00January 22, 2018|Medicaid, Medicaid long-term services and supports|

GAO Urges Medicare Action on Opioids

The Centers for Medicare & Medicaid Services is not doing enough to oversee the prescribing of opioids to Medicare beneficiaries. Or so concludes the U.S. Government Accountability Office. According to the GAO, CMS provides guidance to Medicare drug plans “…but does not analyze data specifically on opioids.” Also, according to the GAO, …CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers. As a result, CMS is lacking information that it could use to assess how [...]

iqtsupport2017-11-13T06:00:13-05:00November 13, 2017|Medicare|

GAO: Improvement Needed in MLTSS Oversight

The Centers for Medicare & Medicaid Services needs to improve the job it does overseeing state Medicaid programs of managed long-term services and supports. According to a new report by the U.S. Government Accountability Office, 22 states use MLTSS programs to help qualified seniors continue living independently in the community and to save money on nursing home costs. CMS’s oversight of these efforts, and of the use of federal funds, is inconsistent and often falls short when monitoring key considerations such as provider network adequacy, critical incidents, and appeals and grievances. To address these concerns, the GAO recommends that CMS [...]

iqtsupport2017-09-21T06:00:37-04:00September 21, 2017|Medicaid, Medicaid long-term services and supports|

GAO Looks at Use of Telehealth in Medicare, Medicaid

The U.S. Government Accountability Office has examined the use of telehealth services in the Medicare and Medicaid programs. In a study that looked at current Medicare practices, sampled Medicaid practices in six states, and consulted selected provider, payment, and patient associations, the GAO evaluated the extent to which telehealth is used in Medicare and Medicaid today, factors that affect the use of telehealth in Medicare, and the degree to which new payment and delivery models might affect future telehealth utilization in Medicare. The report does not offer recommendations. The GAO released its findings in a new report titled Telehealth: Use [...]

iqtsupport2017-07-26T06:00:39-04:00July 26, 2017|Medicaid, Medicare|

HHS Needs to Do More on Physician Training

The federal government needs to do more to ensure an adequate supply of primary care physicians and their deployment in non-urban areas outside of the northeastern U.S. Or so concludes a new study performed by the U.S. Governor Accountability Office. According to the GAO report, efforts by the U.S. Department of Health and Human Services have resulted in progress toward meeting both of these goals – but not enough progress. With the federal government spending $15 billion on graduate medical education, GAO believes, HHS can and should do more to ensure an adequate supply of primary care physicians throughout the [...]

iqtsupport2017-06-28T06:00:41-04:00June 28, 2017|Medicare|

GAO Looks at MLTSS Rates, Oversight

Federal oversight of the manner in which states pay for Medicaid-covered managed long-term services and supports and of the data states use to set the rates for those services and supports is lacking, according to a new study by the U.S. Government Accountability Office. In a review of such practices in six states, GAO found that states are not adequately linking payments and penalties to performance toward achieving MLTSS goals for providing more care in the community and are using outdated data to set rates that federal regulations require to be “appropriate and adequate.” Learn more about what the GAO [...]

iqtsupport2017-02-14T06:00:38-05:00February 14, 2017|Medicaid|