Cost analysis (61 - 70 of 100 items)
Health Centers And Rural Clinics: State and Federal Implementation Issues for Medicaid's New Payment System
GAO-05-452: Published: Jun 17, 2005. Publicly Released: Jun 17, 2005.
The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) established a prospective payment system (PPS) for Medicaid payments to Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC), giving providers a financial incentive to operate efficiently. BIPA requires that BIPA PPS rates be adjusted for inflation and changes in scope of services. States a...
Medicare Chemotherapy Payments: New Drug and Administration Fees Are Closer to Providers' Costs
GAO-05-142R: Published: Dec 1, 2004. Publicly Released: Dec 1, 2004.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required the Secretary of the Department of Health and Human Services to change the payment rates for chemotherapy-related drugs and chemotherapy administration services. These changes followed reports that Medicare payments for chemotherapy-related drugs were much higher than physicians' costs to acquire them, and on...
Medicare: Appropriate Dispensing Fee Needed for Suppliers of Inhalation Therapy Drugs
GAO-05-72: Published: Oct 12, 2004. Publicly Released: Oct 12, 2004.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) revised the payment formula for most of the outpatient drugs, including inhalation therapy drugs, covered under Medicare part B. Under the revised formula, effective 2005, Medicare's payment is intended to be closer to acquisition costs. The Centers for Medicare & Medicaid Services (CMS), the agency that administers M...
Medicare: Information Needed to Assess Adequacy of Rate-Setting Methodology for Payments for Hospital Outpatient Services
GAO-04-772: Published: Sep 17, 2004. Publicly Released: Sep 17, 2004.
Under the Medicare hospital outpatient prospective payment system (OPPS), hospitals receive a temporary additional payment for certain new drugs and devices while data on their costs are collected. In 2003, these payments expired for the first time for many drugs and devices. To incorporate these items into OPPS, the Centers for Medicare & Medicaid Services (CMS) used its rate-setting methodology...
District of Columbia Jail: Medical Services Generally Met Requirements and Costs Decreased, but Oversight Is Incomplete
GAO-04-750: Published: Jun 30, 2004. Publicly Released: Jul 30, 2004.
Since the end of a court-ordered receivership overseeing medical services at the District of Columbia Jail in September 2000, the Department of Corrections (DoC) has contracted with the Center for Correctional Health and Policy Studies, Inc. (CCHPS) to provide inmate medical services. GAO was asked to provide information on (1) the medical services DoC contracted with CCHPS to provide, including C...
Medicare Home Health: Payments to Most Freestanding Home Health Agencies More Than Cover Their Costs
GAO-04-359: Published: Feb 27, 2004. Publicly Released: Feb 27, 2004.
Under Medicare's home health prospective payment system (PPS), home health agencies (HHA) are paid a fixed amount, adjusted for differences in individual patients' expected care needs, for providing an episode (up to 60 days) of care. For this payment, HHAs provide therapy, skilled nursing, medical social service, and aide visits to patients in their homes. GAO previously reported that PPS payment...
Medicaid Nursing Home Payments: States' Payment Rates Largely Unaffected by Recent Fiscal Pressures
GAO-04-143: Published: Oct 17, 2003. Publicly Released: Nov 26, 2003.
Almost half of all Americans over the age of 65 will rely on nursing home care at some point in their lives, and two in three nursing home residents have their care covered at least in part by Medicaid. Under Medicaid, states set nursing home payment rates and the federal government reimburses a share of state spending. According to the most recently available data, Medicaid nursing home expenditu...
Ambulance Services: Medicare Payments Can Be Better Targeted to Trips in Less Densely Populated Rural Areas
GAO-03-986: Published: Sep 19, 2003. Publicly Released: Sep 19, 2003.
The Centers for Medicare & Medicaid Services (CMS) recently implemented a Medicare ambulance fee schedule in which providers are paid a base payment per trip plus a mileage payment. An adjustment is made to the mileage rate for rural trips to account for higher costs. CMS has stated that this rural adjustment may not sufficiently target providers serving sparsely populated rural areas. The Medicar...
Medicare Home Health Payment: Nonroutine Medical Supply Data Needed to Assess Payment Adjustments
GAO-03-878: Published: Aug 15, 2003. Publicly Released: Aug 15, 2003.
Under Medicare's prospective payment system (PPS), home health agencies receive a single payment, adjusted to reflect the care needs of different types of patients, for providing up to 60 days of home health care. Some home health industry representatives have suggested that certain nonroutine medical supplies (such as wound-care dressings) should be excluded from this payment and reimbursed separ...
Medicare: Payment for Blood Clotting Factor Exceeds Providers' Acquisition Cost
GAO-03-184: Published: Jan 10, 2003. Publicly Released: Feb 11, 2003.
In 2001, Medicare's outpatient expenditures for blood clotting factor used to treat the estimated 1,100 beneficiaries with hemophilia totaled about $105 million, or more than 2 percent of total Medicare spending on outpatient drugs. Earlier work by GAO indicated that Medicare's payment for certain outpatient drugs is substantially higher than providers' acquisition costs. Concerns have been raised...