Program management (1 - 10 of 42 items)
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...
Medicaid: Source of Screening Affects Women's Eligibility for Coverage of Breast and Cervical Cancer Treatment in Some States
GAO-09-384: Published: May 22, 2009. Publicly Released: Jun 22, 2009.
Tens of thousands of women die each year from breast or cervical cancer. While screening and early detection through mammograms and Pap tests--followed by treatment--can improve survival, low-income, uninsured women are often not screened. In 1990, Congress authorized the Centers for Disease Control and Prevention (CDC) to fund screening and diagnostic services for such women, which led CDC to est...
Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Funding State Oversight of Health Care Facilities
GAO-09-64: Published: Feb 13, 2009. Publicly Released: Mar 19, 2009.
Americans receive care from tens of thousands of health care facilities participating in Medicare and Medicaid. To ensure the quality of care, CMS contracts with states to conduct periodic surveys and complaint investigations. Federal spending on such activities totaled about $444 million in fiscal year 2007; states are expected to contribute their own funds both through the Medicaid program and a...
Nonprofit Hospitals: Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements
GAO-08-880: Published: Sep 12, 2008. Publicly Released: Oct 14, 2008.
Nonprofit hospitals qualify for federal tax exemption from the Internal Revenue Service (IRS) if they meet certain requirements. Since 1969, IRS has not specified that these hospitals have to provide charity care to meet these requirements, so long as they engage in activities that benefit the community. Many of these activities are intended to benefit the approximately 47 million uninsured indivi...
Medicare and Medicaid: CMS and State Efforts to Interact with the Indian Health Service and Indian Tribes
GAO-08-724: Published: Jul 11, 2008. Publicly Released: Aug 7, 2008.
By law, facilities funded by the Indian Health Service (IHS) may retain reimbursement from Medicare and Medicaid without an offsetting reduction in funding. Ensuring that IHS-funded facilities enroll individuals in--and obtain reimbursement from--Medicare and Medicaid can provide an important means of expanding the funding for health care services for the population served by IHS. The Centers for...
Long-Term Care Insurance: Oversight of Rate Setting and Claims Settlement Practices
GAO-08-712: Published: Jun 30, 2008. Publicly Released: Jul 23, 2008.
As the baby boom generation ages, the demand for long-term care services, which include nursing home care, is likely to grow and could strain state and federal resources. The increased use of long-term care insurance (LTCI) may be a way of reducing the share of long-term care paid by state and federal governments. Oversight of LTCI is primarily the responsibility of states, but over the past 12 ye...
Influenza Pandemic: Federal Agencies Should Continue to Assist States to Address Gaps in Pandemic Planning
GAO-08-539: Published: Jun 19, 2008. Publicly Released: Jul 21, 2008.
The Implementation Plan for the National Strategy for Pandemic Influenza states that in an influenza pandemic, the primary response will come from states and localities. To assist them with pandemic planning and exercising, Congress has provided $600 million to states and certain localities. The Department of Homeland Security (DHS) established five federal influenza pandemic regions to work with...
Emergency Management: GAO Responses to Post-hearing Questions for the Record
GAO-08-1003R: Published: Jul 15, 2008. Publicly Released: Jul 15, 2008.
Members of the Committee requested that GAO provide additional comments to a number of post-hearing questions after GAO testified before the Subcommittee on Management, Investigations, and Oversight on the Department of Homeland Security's (DHS) Preparedness for Catastrophic Disasters. The responses are generally based on work associated with previously issued GAO products, which were conducted in...
Emergency Management: Observations on DHS's Preparedness for Catastrophic Disasters
GAO-08-868T: Published: Jun 11, 2008. Publicly Released: Jun 11, 2008.
The Homeland Security Act was enacted in November 2002, creating the Department of Homeland Security (DHS) to improve homeland security following the September 11, 2001, terrorist attacks on the United States. The act centralized the leadership of many homeland security activities under a single federal department and, accordingly, DHS has the dominant role in implementing this national strategy....