Medicaid: HealthPASS: An Evaluation of a Managed Care Program for Certain Philadelphia Recipients
HRD-93-67
Published: May 07, 1993. Publicly Released: Jun 08, 1993.
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Highlights
Pursuant to a congressional request, GAO reviewed the Philadelphia Accessible Services System's (HealthPASS) medical services, focusing on whether HealthPASS members receive: (1) timely and appropriate pregnancy-related services; (2) early and periodic screening, diagnostic, and treatment (EPSDT) services; and (3) Special Supplemental Food Program for Women, Infants, and Children (WIC) benefits. GAO also reviewed: (1) whether financial incentive arrangements with primary care physicians compromise the quality of care; and (2) the program's quality assurance and credentialing processes.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Congress may wish to consider amending title IV of the Health Care Quality Improvement Act of 1986 (P.L. 99-660) to require health insuring organizations to participate in the National Practitioner Data Bank. By doing so, health insuring organizations like HealthPASS could access information needed to identify unethical or incompetent practitioners. |
Closed – Implemented
|
HCFA took the position that the Social Security Act places responsibility for promoting optional use of WIC upon the state as opposed to Medicaid providers. In addition, federal regulations do not authorize the release of information on Medicaid recipients by providers to whom it was originally released. HCFA therefore took the position that release of names to the WIC agency should be performed by the state Medicaid agency, as opposed to any or all Medicaid providers. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator of the Health Care Financing Administration (HCFA) to require the Pennsylvania Department of Public Welfare and Department of Health to make the necessary arrangements to allow Healthcare Management Alternatives, Inc., (HMA) to provide the names of HealthPASS members to the WIC program. |
Closed – Implemented
HCFA supported this recommendation, in part, and stated that it is desirable for Healthcare Management Alternatives (HMA) to contact the National Practitioner Data Bank as part of its provider credentialing program. Because HMA does not have statutory eligibility, however, HCFA determined that it could not legally require such coordination in its contract.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to direct Pennsylvania to modify its contract with HMA to require HMA to query nationwide information banks to improve the identification of potentially problematic physicians in the HealthPASS program. |
Closed – Implemented
HMA could not get access to the National Practitioner Data Bank because HMA is a health insurance organization. HCFA did not institute a regulation to allow access. However, the HealthPASS program terminates as of December 1996.
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