Medicare (121 - 130 of 1,463 items)
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...
Patient Protection and Affordable Care Act: Status of Federal and State Efforts to Establish Health Insurance Exchanges for Small Businesses
GAO-13-614: Published: Jun 19, 2013. Publicly Released: Jun 19, 2013.
For 2014, the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) granted conditional approval to 18 states to establish state-based Small Business Health Options Programs, or SHOPs, and to 17 states to operate health insurance exchanges for individuals. CMS is required to operate a federally facilitated SHOP (FF-SHOP) and a federally facilitated exchange...
Medicare Program Integrity: Few Payments in 2011 Exceeded Limits under One Kind of Prepayment Control, but Reassessing Limits Could Be Helpful
GAO-13-430: Published: May 9, 2013. Publicly Released: Jun 11, 2013.
Less than 0.1 percent of payments Medicare made in 2011 were for amounts of services that exceeded certain unpublished limits for excess billing and where the claims did not include information from the providers to indicate why the additional services were medically necessary. These limits are set by the Centers for Medicare & Medicaid Services (CMS)--an agency within the Department of Health and...
Medicare Imaging Accreditation: Establishing Minimum National Standards and an Oversight Framework Would Help Ensure Quality and Safety of Advanced Diagnostic Imaging Services
GAO-13-246: Published: May 31, 2013. Publicly Released: May 31, 2013.
The Centers for Medicare & Medicaid Services (CMS) did not establish minimum national standards for the accreditation of suppliers of advanced diagnostic imaging (ADI) services, which cover the production of images for computed tomography, magnetic resonance imaging, and nuclear medicine services. While CMS adopted the broad criteria from the Medicare Improvements for Patients and Providers Act of...
VA Health Care: Management and Oversight of Fee Basis Care Need Improvement
GAO-13-441: Published: May 31, 2013. Publicly Released: May 31, 2013.
The Department of Veterans Affairs' (VA) fee basis care spending increased from about $3.04 billion in fiscal year 2008 to about $4.48 billion in fiscal year 2012. The slight decrease in fiscal year 2012 spending from the fiscal year 2011 level was due to VA's adoption of Medicare rates as its primary payment method for fee basis providers. VA's fee basis care utilization also increased from about...
Patient Protection and Affordable Care Act: Enrollment and Spending in the Early Retiree Reinsurance and Pre-existing Condition Insurance Plan Programs
GAO-13-391: Published: Apr 30, 2013. Publicly Released: May 30, 2013.
The Center for Consumer Information and Insurance Oversight (CCIIO) discontinued enrollment in the Early Retiree Reinsurance Program (ERRP) in early 2011 and stopped most program reimbursements the following year to keep spending within the $5 billion ERRP appropriation. Specifically, anticipating exhaustion of funds, CCIIO stopped ERRP enrollment in May 2011. According to CCIIO officials, CCIIO s...
Medicare: Legislative Modifications Have Resulted in Payment Adjustments for Most Hospitals
GAO-13-334: Published: Apr 17, 2013. Publicly Released: May 16, 2013.
Over time, Congress has modified how Medicare reimburses certain hospitals under the inpatient prospective payment system (IPPS), which pays hospitals a flat fee per stay, set in advance, with different amounts for each type of condition. GAO identified numerous statutory provisions that individually increased Medicare payments to a subset of hospitals.Seven provisions enabled hospitals to be paid...
Medicaid: Alternative Measures Could Be Used to Allocate Funding More Equitably
GAO-13-434: Published: May 10, 2013. Publicly Released: May 10, 2013.
GAO identified multiple data sources that could be used to develop measures to allocate Medicaid funding to states more equitably than the current funding formula--known as the Federal Medical Assistance Percentage (FMAP)--which is based solely on per capita income (PCI). To be equitable from the perspective of beneficiaries and allow states to provide a comparable level of services to each person...
CMS: Activities, Staffing, and Funding for the Center for Strategic Planning
GAO-13-377R: Published: Apr 1, 2013. Publicly Released: May 1, 2013.
CSP's activities, staff, and funding support strategic planning by individual CMS offices and centers as well as the agency itself. CMS officials told us that CSP assists individual offices and centers in developing strategic plans for their units, leads the agency's senior-level strategic planning meetings, and is helping to develop a centralized approach to monitor the implementation of CMS's ag...
Medicaid: Enhancements Needed for Improper Payments Reporting and Related Corrective Action Monitoring
GAO-13-229: Published: Mar 29, 2013. Publicly Released: May 1, 2013.
The Centers for Medicare & Medicaid Services' (CMS) methodology for estimating a national improper payment rate for the Medicaid program is statistically sound. However, CMS's procedures did not provide for updating state data used in its methodology to recognize significant corrections or adjustments after the cutoff date. The Office of Management and Budget (OMB) requires that federal agencies e...