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Domestic Policy Council, Executive Office of the President, Executive (111 - 120 of 396 items)
Medicare HMOs: Setting Payment Rates Through Competitive Bidding
HEHS-97-154R: Published: Jun 12, 1997. Publicly Released: Jun 12, 1997.
GAO reviewed the Health Care Financing Administration's (HCFA) proposed use of competitive bidding as an alternative method for setting Medicare health maintenance organization (HMO) payment rates, focusing on: (1) the potential advantages of competitive bidding in the Medicare HMO program; (2) the main features of HCFA's planned competitive bidding demonstration in Denver; and (3) HMO's key objec...
Medicare Managed Care: HMO Rates, Other Factors Create Uneven Availability of Benefits
T-HEHS-97-133: Published: May 19, 1997. Publicly Released: May 19, 1997.
GAO discussed aspects of Medicare managed care, including greater choice and equity across the program, focusing on: (1) the link between counties' capitation rates and Medicare's spending on fee-for-service care; (2) factors affecting the availability of plans in a given area, the level of premiums charged, and the benefit packages offered; and (3) modifications to Medicare's current payment meth...
Medicare and Medicaid: Meeting Needs of Dual Eligibles Raises Difficult Cost and Care Issues
T-HEHS-97-119: Published: Apr 29, 1997. Publicly Released: Apr 29, 1997.
Pursuant to a congressional request, GAO discussed several issues that arise in financing health care for people known as dual eligibles, Medicare beneficiaries who are also eligible for some form of Medicaid support, focusing on: (1) the health characteristics of those who are eligible for both Medicare and Medicaid and the key structural differences between the two programs that serve this popul...
Medicare Managed Care: HCFA Missing Opportunities to Provide Consumer Information
T-HEHS-97-109: Published: Apr 10, 1997. Publicly Released: Apr 10, 1997.
GAO discussed: (1) Medicare beneficiaries' need for comparative information on health maintenance organizations (HMO); and (2) steps the Health Care Financing Administration (HCFA) could take to meet that need promptly.GAO noted that: (1) HCFA does not distribute to beneficiaries comparative consumer guides such as those the federal government and many employer-based health insurance programs rout...
Skilled Nursing Facilities: Approval Process for Certain Services May Result in Higher Medicare Costs
HEHS-97-18: Published: Dec 20, 1996. Publicly Released: Jan 22, 1997.
Pursuant to a congressional request, GAO reviewed: (1) the growth of skilled nursing facility (SNF) costs and SNF use in relation to hospital use; (2) the characteristics of Medicare SNF patients and the types of services they receive in SNFs being paid higher than normal amounts compared to other SNFs, as well as whether patients in such facilities receive appropriate care; and (3) whether the He...
Medicare: HCFA Should Release Data to Aid Consumers, Prompt Better HMO Performance
HEHS-97-23: Published: Oct 22, 1996. Publicly Released: Oct 31, 1996.
Pursuant to a congressional request, GAO reviewed the marketing, education, and enrollment practices of health maintenance organizations (HMO) participating in the Medicare risk-contract program, focusing on whether: (1) the Health Care Financing Administration (HCFA) provides Medicare beneficiaries with sufficient information about Medicare HMO; and (2) available HCFA data could be used to cautio...
Medicaid: States' Efforts to Educate and Enroll Beneficiaries in Managed Care
HEHS-96-184: Published: Sep 17, 1996. Publicly Released: Oct 29, 1996.
Pursuant to a congressional request, GAO provided information on state efforts to enroll Medicaid beneficiaries in managed care, focusing on: (1) the role of managed care organizations (MCO) in marketing and expanding managed care participation; (2) the types of marketing and enrollment abuses that have occurred and states' efforts to curb these abuses and ensure that beneficiaries are informed ab...
Social Security Disability: Improvements Needed to Continuing Disability Review Process
HEHS-97-1: Published: Oct 16, 1996. Publicly Released: Oct 29, 1996.
Pursuant to a congressional request, GAO provided information on how to improve the Social Security Administration's (SSA) continuing disability reviews (CDR) process for Disability Insurance (DI) and Supplemental Security Income (SSI) beneficiaries, focusing on: (1) the number and characteristics of individuals who are due for CDR; (2) how SSA selects individuals for and conducts CDR; (3) whether...
Managed Care Initiatives
HEHS-96-153R: Published: Sep 25, 1996. Publicly Released: Oct 28, 1996.
Pursuant to a congressional request, GAO provided information on: (1) tools that managed care plans use to control costs; and (2) state initiatives that address concerns associated with managed care. GAO noted that managed care plans use a variety of tools to control costs, including: (1) shifting some financial risk to providers; (2) requiring plan permission to refer a patient to a specialist; a...
Medicaid: Waiver Program for Developmentally Disabled Is Promising But Poses Some Risks
HEHS-96-120: Published: Jul 22, 1996. Publicly Released: Jul 22, 1996.
Pursuant to a congressional request, GAO reviewed states' experiences in utilizing the Medicaid waiver program to provide care for developmentally disabled adults in alternative settings, focusing on: (1) expanding state use of the waiver program; (2) controlling long-term care costs for developmentally disabled individuals; and (3) the strengths and limitations in states' quality assurance approa...