Federal spending (1 - 7 of 7 items) in Past Year
Medicaid: CMS Needs Better Data to Monitor the Provision of and Spending on Personal Care Services
GAO-17-169: Published: Jan 12, 2017. Publicly Released: Feb 13, 2017.
Two data systems managed by the Centers for Medicare & Medicaid Services (CMS)—the federal agency that oversees Medicaid—collect information from states on the provision of and spending on personal care services:The Medicaid Statistical Information System (MSIS) collects detailed information from provider claims on services rendered to individual Medicaid beneficiaries and state payments for t...
Medicaid: Program Oversight Hampered by Data Challenges, Underscoring Need for Continued Improvements
GAO-17-173: Published: Jan 6, 2017. Publicly Released: Feb 6, 2017.
GAO found that available Medicaid expenditure and utilization data do not provide CMS with sufficient information to consistently ensure that payments are proper or that beneficiaries have access to covered services. The Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS) that administers the Medicaid program, relies on two key data s...
Medicaid: CMS Has Taken Steps, but Further Efforts Are Needed to Control Improper Payments
GAO-17-386T: Published: Jan 31, 2017. Publicly Released: Jan 31, 2017.
GAO's prior work has identified four Medicaid program integrity issues—where the program is vulnerable to improper payments such as those made for services that were not covered, were not medically necessary, or were not provided—as well as actions taken by the Centers for Medicare & Medicaid Services (CMS) to address the issues and additional actions that should be taken.Enrollment Verificati...
Medicaid: Key Policy and Data Considerations for Designing a Per Capita Cap on Federal Funding
GAO-16-726: Published: Aug 10, 2016. Publicly Released: Sep 9, 2016.
Through review of its prior reports, the literature and interviews with state Medicaid officials and subject matter experts, GAO identified several key interrelated policy considerations that could be useful should policymakers elect to pursue a per capita cap—a per-enrollee limit on federal Medicaid funding for states.Coverage and flexibility. Coverage entails decisions about whether all or a s...
Medicare: 2016 Payment Rates for Complex Wheelchair Accessories
GAO-16-840R: Published: Aug 31, 2016. Publicly Released: Aug 31, 2016.
GAO reviewed 2016 Medicare payment rates for complex wheelchair accessories—both the fully adjusted rates based on the durable medical equipment competitive bidding program (CBP) and the unadjusted rates for the same items. The Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—classifies power wheelchairs into five groups ranging from wheelchairs wi...
Medicare Part B: Data on Coupon Discounts Needed to Evaluate Methodology for Setting Drug Payment Rates
GAO-16-643: Published: Jul 27, 2016. Publicly Released: Aug 26, 2016.
In 2015, manufacturers of 29 of the 50 high-expenditure Medicare Part B drugs GAO analyzed offered coupon programs, which reduce the costs patients incur for specific drugs. Part B drugs are typically administered by a physician. Coupon programs are prohibited in the Medicare program but are generally available to privately insured patients. GAO obtained data on coupon discounts for 18 drugs. GAO...
Medicare Part B: CMS Should Take Additional Steps to Verify Accuracy of Data Used to Set Payment Rates for Drugs
GAO-16-594: Published: Jul 1, 2016. Publicly Released: Aug 1, 2016.
In 2014, the most recent year for which data were available, the Medicare program and its beneficiaries spent about $21 billion on approximately 46 million administrations of 551 Part B drugs paid based on average sales price (ASP). Six drugs—each exceeding $1 billion in expenditures—accounted for 36 percent of all expenditures on Part B ASP drugs, while a different 10 drugs—each administere...