Managed health care (71 - 80 of 209 items)
Medicare: Most Beneficiaries Receive Some but Not All Recommended Preventive Services
GAO-03-958: Published: Sep 8, 2003. Publicly Released: Oct 8, 2003.
Medicare, the federal health program insuring almost 35 million beneficiaries age 65 and older, covers certain preventive services, such as flu shots and mammograms. Most beneficiaries receive care through Medicare's fee-for-service program, under which they generally receive these services as part of visits to the doctor for specific illnesses or conditions. Other beneficiaries receive services u...
Medicare: Discrepancy in Hospital Outpatient Prospective Payment System Methodology Leads to Inaccurate Beneficiary Copayments and Medicate Payments
GAO-04-103R: Published: Oct 6, 2003. Publicly Released: Oct 6, 2003.
Under the Medicare hospital outpatient prospective payment system (OPPS), beneficiaries can be responsible for paying 50 percent or more of the total payment for outpatient services they receive in hospitals. The Balanced Budget Act of 1997 (BBA) introduced a mechanism to gradually decrease beneficiary cost sharing to 20 percent of the payment rate for each hospital outpatient service. The Centers...
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...
Prescription Drug Discount Cards: Savings Depend on Pharmacy and Type of Card Used
GAO-03-912: Published: Sep 3, 2003. Publicly Released: Sep 8, 2003.
While prescription drugs have become an increasingly important part of health care for the elderly, more than one-quarter of all Medicare beneficiaries have no prescription drug coverage. Over the past decade, private companies and not-for-profit organizations have sponsored prescription drug discount cards that offer discounts from the prices the elderly would otherwise have to pay for their pres...
Medicaid Formula: Differences in Funding Ability among States Often Are Widened
GAO-03-620: Published: Jul 10, 2003. Publicly Released: Aug 11, 2003.
A primary goal in establishing Medicaid's statutory formula, whereby states with lower per capita incomes (PCI) receive higher rates of federal reimbursement for program costs, was to narrow differences among states in their ability to fund Medicaid services. States' ability to fund services depends on their financial resources in relation to their number of and costs to serve people in poverty. G...
Defense Health Care: Oversight of the TRICARE Civilian Provider Network Should Be Improved
GAO-03-928: Published: Jul 31, 2003. Publicly Released: Jul 31, 2003.
Testifying before Congress in 2002, military beneficiary groups described problems accessing care from TRICARE's civilian medical providers. Providers also testified on their dissatisfaction with the TRICARE program, specifying low reimbursement rates and administrative burdens. The Bob Stump National Defense Authorization Act of 2003 required GAO to review the oversight of the TRICARE network of...
DOD and VA Health Care: Access for Dual Eligible Beneficiaries
GAO-03-904R: Published: Jun 13, 2003. Publicly Released: Jun 13, 2003.
The Department of Defense (DOD) reported that under its current policy, beneficiaries eligible for both TRICARE and the Department of Veterans Affairs' (VA) health care (dual eligible beneficiaries) are not allowed to utilize the services offered by both health care systems for treatment for the same episode of care. For example, if a beneficiary experiences back pain and seeks treatment from VA,...
Medicaid and Ticket to Work: States' Early Efforts to Cover Working Individuals with Disabilities
GAO-03-587: Published: Jun 13, 2003. Publicly Released: Jun 13, 2003.
Over 7 million individuals with disabilities rely on medical and supportive services covered by Medicaid. However, if working-age individuals with disabilities desire to increase their self-sufficiency through employment, they could jeopardize their eligibility for Medicaid coverage, possibly leaving them without an alternative for health insurance. In an effort to help extend Medicaid coverage to...
Medicare: Divided Authority for Policies on Coverage of Procedures and Devices Results in Inequities
GAO-03-175: Published: Apr 11, 2003. Publicly Released: May 12, 2003.
Critical choices on whether new technology will be covered for Medicare's 40 million beneficiaries are made nationally by the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--or locally by contractors that process and pay claims. GAO was asked to review the degree to which new procedures and devices are incorporated into Medicare, the effect of Medicare coverag...
Medicare: Financial Challenges and Considerations for Reform
GAO-03-577T: Published: Apr 10, 2003. Publicly Released: Apr 10, 2003.
We are pleased to be here today as Congress examines Medicare's financial health and consider the budgetary and economic challenges presented by an aging society. The Comptroller General has been particularly attentive to the sustainability challenges faced by the nation's two largest entitlement programs--Medicare and Social Security--for more than a decade since he served as a public trustee for...