Managed health care (41 - 50 of 123 items)
TRICARE: Changes to Access Policies and Payment Rates for Services Provided by Civilian Obstetricians
GAO-07-941R: Published: Jul 31, 2007. Publicly Released: Jul 31, 2007.
About 111,000 women covered by the Department of Defense's (DOD) TRICARE program gave birth during 2006. During their pregnancies, about half of these women received obstetric care from physicians and other providers practicing at military hospitals and clinics called military treatment facilities (MTF), while half received their care from civilian physicians and other civilian providers. In recen...
Medicaid: Concerns Remain about Sufficiency of Data for Oversight of Children's Dental Services
GAO-07-826T: Published: May 2, 2007. Publicly Released: May 2, 2007.
The 31 million children enrolled in Medicaid are particularly vulnerable to tooth decay, which, if untreated, may lead to more serious health conditions and, on rare occasion, result in death. Congress established a comprehensive health benefit for children enrolled in Medicaid to cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, which include dental services. The Cen...
Medicaid Managed Care: Access and Quality Requirements Specific to Low-Income and Other Special Needs Enrollees
GAO-05-44R: Published: Dec 8, 2004. Publicly Released: Dec 8, 2004.
The use of managed care within Medicaid, a joint federal-state program that finances health insurance for certain low-income families with children and individuals who are aged or disabled, increased significantly during the 1990s. By 2003, 59 percent of Medicaid beneficiaries were enrolled in managed care, compared with less than 10 percent in 1991. Medicaid managed care, under which states make...
Medicare: Payment Changes Are Needed for Assistants-at-Surgery
GAO-04-97: Published: Jan 13, 2004. Publicly Released: Jan 13, 2004.
Medicare pays for assistant-atsurgery services under both the hospital inpatient prospective payment system and the physician fee schedule. Payments under the physician fee schedule are limited to a few health professions. In 2001, Congress directed GAO to report on the potential impact on the Medicare program of allowing physician fee schedule payments to Certified Registered Nurse First Assistan...
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...
Defense Health Care: TRICARE Claims Processing Has Improved but Inefficiencies Remain
GAO-04-69: Published: Oct 15, 2003. Publicly Released: Oct 15, 2003.
Testifying before Congress in 2002, military beneficiary groups and civilian managed care support contractors described problems with the processing of TRICARE claims for civilian-provided care. These problems included slow payments and procedures that made claims processing inefficient. The Bob Stump National Defense Authorization Act of 2003 required GAO to review improvements to TRICARE claims...
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...
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...
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...
Medicare Provider Enrollment: Opportunities to Enhance Program Integrity Efforts
GAO-03-185: Published: Mar 17, 2003. Publicly Released: Mar 17, 2003.
Staffing companies that contract with physicians to staff hospital departments--including emergency departments--are not permitted to bill Medicare. In the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Congress directed GAO to assess the program integrity implications of enrolling these companies and allowing them to bill Medicare. GAO reviewed about 2.8 million em...