U.S. Government Accountability Office

Number of Medicare-Dependent Hospitals Declines

The number of Medicare-dependent hospitals in the U.S. fell 28 percent between 2011 and 2017, the U.S. Government Accountability Office reports. Medicare-dependent hospitals receive additional payments from Medicare if at least 60 percent of their discharges or inpatient days are associated with Medicare patients, if they have 100 or fewer beds, and if their historic costs in one of three base years are greater than what they would have been paid through Medicare’s inpatient prospective payment system. The Medicare-dependent program was created in 1989 to protect vulnerable small, mostly rural hospitals, and in any given year not all eligible hospitals [...]

iqtsupport2020-03-03T06:00:53-05:00March 3, 2020|Medicare, Medicare reimbursement policy|

Medicaid Waiver Process Often Lacks Transparency, GAO Finds

States’ applications for federal Medicaid waivers often lack transparency, according to a new report by the U.S. Government Accountability Office. According to the GAO, the chief problem with the transparency of state applications for Medicaid waivers arises when states either seek to amend waivers they have already obtained or amend waiver applications currently under review by the Centers for Medicare & Medicaid Services. Too often, the GAO found, states neither subject such amendments to public review and comment nor adequately explain to stakeholders the implications of the amendments they are proposing. To address this problem, the GAO recommends that CMS [...]

iqtsupport2019-05-23T09:52:40-04:00May 23, 2019|Medicaid|

Hospitals Flee Downside Risk in Medicare Bundled Programs

More than half of the hospitals that voluntary participate in Medicare bundled payment model programs leave those programs when faced with the possibility of financial penalties based on their performance. So concludes a new report by the U.S. Government Accountability Office. Some of these models feature both “upside” and “downside” risk. Upside risk offers financial incentives to participants that keep their costs below targeted amounts; they share those savings with Medicare. Downside risk occurs when hospitals are penalized when their costs exceed agreed-upon targets. Some of the model programs begin with only upside risk and later move into both upside [...]

iqtsupport2019-01-29T06:00:06-05:00January 29, 2019|Alternative payment models, hospitals, Medicare|

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: 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|

Behavioral Health Services in Medicaid Expansion States

The U.S. Government Accountability Office has performed a limited study of the utilization of Medicaid behavioral health services in Medicaid expansion states. The study, based on data from New York, Washington, Iowa, and West Virginia, found that the two most heavily utilized behavioral health services were diagnostic and psychotherapy services and that more than two-thirds of behavioral health patients were prescribed anti-depressants. More people sought help for mental health challenges that for substance abuse problems. Medicaid officials in the selected states concluded that enrollment in Medicaid enhanced access to behavioral health care. Learn more about the study’s findings in the [...]

iqtsupport2017-07-28T06:00:52-04:00July 28, 2017|Affordable Care Act, Medicaid|

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|