Managed health care (81 - 90 of 209 items)
Medicare: Observations on Program Sustainability and Strategies to Control Spending on Any Proposed Drug Benefit
GAO-03-650T: Published: Apr 9, 2003. Publicly Released: Apr 9, 2003.
The House Committee on Ways and Means is holding a hearing on modernizing Medicare and integrating prescription drugs into the program. There are growing concerns about gaps in the Medicare program, most notably the lack of outpatient prescription drug coverage, which may leave Medicare's most vulnerable beneficiaries with high out-of-pocket costs. At the same time, Medicare already faces a huge p...
Defense Health Care: Oversight of the Adequacy of TRICARE's Civilian Provider Network Has Weaknesses
GAO-03-592T: Published: Mar 27, 2003. Publicly Released: Mar 27, 2003.
During 2002, in testimony to the House Armed Services Committee, Subcommittee on Personnel, beneficiary groups described problems with access to care from TRICARE's civilian providers, and providers testified about their dissatisfaction with the TRICARE program, specifying low reimbursement rates and administrative burdens. The Bob Stump National Defense Authorization Act of 2003 required that GAO...
Medicaid and SCHIP: States Use Varying Approaches to Monitor Children's Access to Care
GAO-03-222: Published: Jan 14, 2003. Publicly Released: Feb 14, 2003.
Over 25 million children have health insurance coverage through Medicaid or the State Children's Health Insurance Program (SCHIP). Coverage alone, however, does not guarantee that services will be available or that children will receive needed care. GAO was asked to evaluate states' efforts to facilitate and monitor access to primary and preventive services for children in these jointly funded fed...
Medicare+Choice: Selected Program Requirements and Other Entities' Standards for HMOs
GAO-03-180: Published: Oct 31, 2002. Publicly Released: Dec 2, 2002.
Since the early 1980s, health maintenance organizations (HMO) have entered into risk-based contracts with Medicare and offered beneficiaries an alternative to the traditional fee-for-service (FFS) program. By 1997, 5.2 million Medicare beneficiaries were enrolled in an HMO. Although Medicare HMOs were available in most urban areas, they were often unavailable in rural areas. Medicare+Choice (M+C)...
Health Insurance: States' Protections and Programs Benefit Some Unemployed Individuals
GAO-03-191: Published: Oct 25, 2002. Publicly Released: Nov 27, 2002.
The six states reviewed had in place a variety of protections, established prior to the economic downturn, to assist unemployed individuals in maintaining health insurance coverage: State-mandated continuation coverage, which required small businesses to extend their group health coverage to former employees and their families who choose to pay for it. Guaranteed conversion, which required insurer...
Defense Health Care: Most Reservists Have Civilian Health Coverage but More Assistance Is Needed When TRICARE Is Used
GAO-02-829: Published: Sep 6, 2002. Publicly Released: Sep 6, 2002.
To expand the capabilities of the nation's active duty forces, the Department of Defense (DOD) relies on the 1.2 million men and women of the Reserve and National Guard. Currently, reserve components constitute nearly half of the total armed forces. Although DOD requires reservists to use TRICARE DOD's health care system for their own health care, using TRICARE is an option for their dependents. N...
Medicaid and SCHIP: Recent HHS Approvals of Demonstration Waiver Projects Raise Concerns
GAO-02-817: Published: Jul 12, 2002. Publicly Released: Aug 7, 2002.
States provide health care coverage to about 40 million uninsured, low-income adults and children under two federal-state programs--Medicaid and the State Children's Health Insurance Program (SCHIP). To receive federal funding, states must meet statutory requirements, including providing certain levels of benefits to specified populations. Under section 1115 of the Social Security Act, the Secreta...
Medicare: Recent CMS Reforms Address Carrier Scrutiny of Physicians' Claims for Payment
GAO-02-693: Published: May 28, 2002. Publicly Released: May 28, 2002.
In 1990, GAO designated the Medicare program to be at high-risk for waste, fraud, and abuse. More than a decade later, Medicare remains on GAO's high-risk list. This report examines Medicare's claims review process, which is designed to detect improper billing or payments. GAO found that most physicians who bill Medicare are largely unaffected by carriers' medical reviews, with 90 percent of physi...
Medicare: Use of Preventive Services is Growing but Varies Widely
GAO-02-777T: Published: May 23, 2002. Publicly Released: May 23, 2002.
Preventive health care services can extend lives and promote the well being of the nation's seniors. Medicare now covers 10 preventive services--three types of immunizations and seven types of screenings--and legislation has been introduced to cover additional services. However, not all beneficiaries avail themselves of Medicare's preventive services. Some may simply choose not to use them, but ot...
Medicare Home Health Care: Payments to Home Health Agencies Are Considerably Higher than Costs
GAO-02-663: Published: May 6, 2002. Publicly Released: May 6, 2002.
The Balanced Budget Act of 1997 significantly changed Medicare's home health care payments to home health agencies (HHAs). Under a prospective payment system (PPS), HHAs are paid a fixed amount, adjusted for beneficiary care needs, for providing up to 60 days of care---termed a "home health episode." The act also imposed new interim payment limits to moderate spending until the PPS could be imple...