Health care costs (11 - 20 of 541 items)
Private Health Insurance: Early Evidence Finds Premium Tax Credit Likely Contributed to Expanded Coverage, but Some Lack Access to Affordable Plans
GAO-15-312: Published: Mar 23, 2015. Publicly Released: Mar 23, 2015.
Early evidence suggests that the advance premium tax credit (APTC)—the refundable tax credit that can be paid on an advance basis—likely contributed to an expansion of health insurance coverage in 2014 because it significantly reduced the cost of exchange plans' premiums for those eligible. Although there are limitations to measuring the effects of the APTC using currently available data, surv...
Medicaid Financing: States' Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection [Reissued on March 13, 2015]
GAO-14-627: Published: Jul 29, 2014. Publicly Released: Jul 29, 2014.
GAO found, based on a questionnaire sent to state Medicaid agencies, that states financed 26 percent, or over $46 billion, of the nonfederal share of Medicaid expenditures with funds from health care providers and local governments in state fiscal year 2012. State funds were most of the remaining nonfederal share.Nationally, states increasingly relied on funds from providers and local governments...
Antipsychotic Drug Use: HHS Has Initiatives to Reduce Use among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings
GAO-15-211: Published: Jan 30, 2015. Publicly Released: Mar 2, 2015.
Antipsychotic drugs are frequently prescribed to older adults with dementia. GAO's analysis found that about one-third of older adults with dementia who spent more than 100 days in a nursing home in 2012 were prescribed an antipsychotic, according to data from Medicare's prescription drug program, also known as Medicare Part D. Among Medicare Part D enrollees with dementia living outside of a nurs...
Improper Payments: TRICARE Measurement and Reduction Efforts Could Benefit from Adopting Medical Record Reviews
GAO-15-269: Published: Feb 18, 2015. Publicly Released: Feb 18, 2015.
The Defense Health Agency (DHA), the agency within the Department of Defense (DOD) responsible for administering the military health program known as TRICARE, uses a methodology for measuring TRICARE improper payments that is less comprehensive than the methodology used to measure improper payments in Medicare, the federal health care program for the elderly and certain disabled individuals. Both...
Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings
GAO-14-523: Published: Aug 29, 2014. Publicly Released: Sep 29, 2014.
Overall spending for high-expenditure disabled dual-eligible beneficiaries—those in the top 20 percent of spending in their respective states—was driven largely by Medicaid spending, and the service use and health status often differed widely between those with high Medicare expenditures and high Medicaid expenditures. For these beneficiaries, Medicaid expenditures accounted for nearly two-thi...
Patient Protection and Affordable Care Act: Largest Issuers of Health Coverage Participated in Most Exchanges, and Number of Plans Available Varied
GAO-14-657: Published: Aug 29, 2014. Publicly Released: Sep 29, 2014.
Most of the largest issuers of health coverage from 2012 participated in the exchanges that the Patient Protection and Affordable Care Act (PPACA) required be established in all states in 2014. Previously, in 2012, while a large number of issuers participated in state individual and small-group markets, a small number of these participating issuers held a majority of the market share in terms of e...
Health Resources and Services Administration: Action Taken to Train and Oversee Grantee Monitoring Staff, but Certain Guidance Could Be Improved
GAO-14-800: Published: Sep 23, 2014. Publicly Released: Sep 23, 2014.
In 2012, the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA) began systematically developing guidance for the key staff involved in grantee monitoring—project officers in its programmatic bureaus and grants management specialists and financial integrity staff in its Office of Federal Assistance Management (OFAM). Specifically, HRSA issued the fi...
Health Insurance Exchanges: Coverage of Non-excepted Abortion Services by Qualified Health Plans
GAO-14-742R: Published: Sep 15, 2014. Publicly Released: Sep 16, 2014.
Under the Patient Protection and Affordable Care Act (PPACA), insurance plans offered in health insurance exchanges—known as qualified health plans (QHP)—may cover abortion services as a benefit consistent with federal and state law. Federal law applicable to QHPs for the 2014 benefit year prohibits the use of federal funds made available to offset the cost of QHP coverage to pay for abortion...
Medicare Advantage: CMS Should Fully Develop Plans for Encounter Data and Assess Data Quality before Use
GAO-14-571: Published: Jul 31, 2014. Publicly Released: Sep 2, 2014.
The Centers for Medicare & Medicaid Services (CMS) is collecting Medicare Advantage (MA) encounter data—information on the services and items furnished to enrollees—that are more comprehensive than the beneficiary diagnosis data the agency currently uses to risk adjust capitated payments to MA organizations (MAO). CMS, an agency within the Department of Health and Human Services (HHS), makes t...
Defense Health Care Reform: Actions Needed to Help Realize Potential Cost Savings from Medical Education and Training
GAO-14-630: Published: Jul 31, 2014. Publicly Released: Jul 31, 2014.
In its 2013 plans for the implementation of the Defense Health Agency (DHA), the Department of Defense (DOD) outlined the responsibilities of a new Education and Training Directorate, but has not demonstrated how its proposed reforms will result in cost savings. The National Defense Authorization Act for Fiscal Year 2013 required DOD to develop business case analyses for its shared service proposa...