Program management (11 - 20 of 126 items)
Patient Protection and Affordable Care Act: Status of CMS Efforts to Establish Federally Facilitated Health Care Exchanges and the Federal Data Services Hub
GAO-13-786T: Published: Jul 17, 2013. Publicly Released: Jul 17, 2013.
In brief, GAO's work found that CMS will operate a health insurance exchange in the 34 states that will not operate a state-based exchange for 2014. While CMS will retain full authority over each of these 34 FFEs, it planned to allow 15 of these states to assist it in carrying out certain FFE functions. However, the activities that CMS plans to carry out in these 15 exchanges, as well as in the 17...
VA Health Care: Additional Steps Needed to Strengthen Beneficiary Travel Program Management and Oversight
GAO-13-632: Published: Jul 15, 2013. Publicly Released: Jul 15, 2013.
The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) has developed efforts to improve the Beneficiary Travel Program, but lack of internal controls may impede their effectiveness. Specifically, VHA has developed multiple efforts to improve the management and oversight of its process for reimbursing veterans' travel expenses for medical appointments, as well as the timeline...
Patient Protection and Affordable Care Act: Status of CMS Efforts to Establish Federally Facilitated Health Insurance Exchanges
GAO-13-601: Published: Jun 19, 2013. Publicly Released: Jun 19, 2013.
The Centers for Medicare & Medicaid Services (CMS) will operate a health insurance exchange in the 34 states that will not operate a state-based exchange for 2014. Of these 34 federally facilitated exchanges (FFE), 15 are in states expected to assist CMS in carrying out certain FFE functions. However, the activities that CMS plans to carry out in these 15 exchanges, as well as in the state-based e...
GAO's 2013 High-Risk Update: Medicare and Medicaid
GAO-13-433T: Published: Feb 27, 2013. Publicly Released: Feb 27, 2013.
Medicare Program: CMS has not met GAO's criteria to have the Medicare program removed from the High-Risk List. For example, although CMS has made progress in measuring and reducing improper payment rates in different parts of the program, it has yet to demonstrate sustained progress in lowering the rates. Because the size of Medicare relative to other programs leads to aggregate improper payments...
Medicare Part D Coverage Gap: Discount Program Effects and Brand-Name Drug Price Trends
GAO-12-914: Published: Sep 28, 2012. Publicly Released: Oct 26, 2012.
As part of Medicare's Part D Coverage Gap Discount Program (Discount Program), the Centers for Medicare & Medicaid Services (CMS), located within the Department of Health and Human Services (HHS), oversees the provision of discounts by plan sponsors to eligible beneficiaries when they purchase brand-name drugs and monitors that discounts are paid for by drug manufacturers. CMS checks prescription...
Medicare Savings Programs: Implementation of Requirements Aimed at Increasing Enrollment
GAO-12-871: Published: Sep 14, 2012. Publicly Released: Sep 14, 2012.
The Social Security Administration (SSA) took a number of steps to implement the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requirements aimed at eliminating barriers to Medicare Savings Program (MSP) enrollment and spent about $12 million in fiscal years 2009 through 2011 to do so. SSA reported transferring over 1.9 million Low-Income Subsidy (LIS) program applications t...
Pre-Existing Condition Insurance Plan: Comparison of Implementation and Early Enrollment with the Children's Health Insurance Program
GAO-12-62R: Published: Nov 10, 2011. Publicly Released: Dec 13, 2011.
The federal Pre-Existing Condition Insurance Plan (PCIP) was created in 2010 to provide access to insurance for individuals previously unable to acquire coverage due to pre-existing conditions. Eligibility is limited to those who have been uninsured for at least 6 months prior to application, thus focusing the program on those who have been locked out of the private insurance market. The Patient P...
Medicaid Program Integrity: Expanded Federal Role Presents Challenges to and Opportunities for Assisting States
GAO-12-288T: Published: Dec 7, 2011. Publicly Released: Dec 7, 2011.
The Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid, estimated that improper payments in the federal-state Medicaid program were $21.9 billion in fiscal year 2011. The Deficit Reduction Act of 2005 established the Medicaid Integrity Program and gave CMS an expanded role in assisting and improving the effectiveness of state activities to ensure proper payme...
Indian Health Service: Increased Oversight Needed to Ensure Accuracy of Data Used for Estimating Contract Health Service Need
GAO-11-767: Published: Sep 23, 2011. Publicly Released: Sep 23, 2011.
The Indian Health Service (IHS), an agency in the Department of Health and Human Services (HHS), provides health care to American Indians and Alaska Natives. When care at an IHS-funded facility is unavailable, IHS's contract health services (CHS) program pays for care from external providers if the patient meets certain requirements and funding is available. The Patient Protection and Affordable C...
Drug Pricing: Manufacturer Discounts in the 340B Program Offer Benefits, but Federal Oversight Needs Improvement
GAO-11-836: Published: Sep 23, 2011. Publicly Released: Sep 23, 2011.
The Health Resources and Services Administration (HRSA), within in the Department of Health and Human Services (HHS), oversees the 340B Drug Pricing Program, through which participating drug manufacturers give certain entities within the health care safety net--known as covered entities--access to discounted prices on outpatient drugs. Covered entities include specified federal grantees and hospit...