Medicaid (101 - 110 of 1,026 items)
Private Health Insurance: Expiration of the Health Coverage Tax Credit Will Affect Participants' Costs and Coverage Choices as Health Reform Provisions Are Implemented
GAO-13-147: Published: Dec 28, 2012. Publicly Released: Jan 28, 2013.
Expiration of the Health Coverage Tax Credit (HCTC) and implementation of Patient Protection and Affordable Care Act (PPACA) premium tax credits, cost-sharing subsidies, and Medicaid expansion will affect HCTC participants' costs for health plans in multiple ways. Projections from GAO's analysis of 2010 Internal Revenue Service (IRS) data show that most HCTC participants in 2014 will likely be eli...
Medicaid: Enrollment and Expenditures for Qualified Individual and Transitional Medical Assistance Programs
GAO-13-177R: Published: Dec 12, 2012. Publicly Released: Jan 11, 2013.
The QI program enrolled about 426,000 individuals nationwide in 2009--the most recent year for which comprehensive enrollment data were available--with expenditures of about $431 million. While QI enrollment increased 30 percent from fiscal year 2006 to fiscal year 2009, program expenditures increased at a slightly faster rate, rising 39 percent during this time. On average, one quarter of individ...
Children's Mental Health: Concerns Remain about Appropriate Services for Children in Medicaid and Foster Care
GAO-13-15: Published: Dec 10, 2012. Publicly Released: Jan 9, 2013.
An annual average of 6.2 percent of noninstitutionalized children in Medicaid nationwide and 4.8 percent of privately insured children took one or more psychotropic medications, according to GAO's analysis of 2007-2009 data from the Department of Health and Human Services' (HHS) Medical Expenditure Panel Survey (MEPS). MEPS data also showed that children in Medicaid took antipsychotic medications...
Medicaid and CHIP: Considerations for Express Lane Eligibility
GAO-13-178R: Published: Dec 5, 2012. Publicly Released: Dec 21, 2012.
Four key considerations related to ELE's availability beyond 2013 include (1) the potential for administrative savings; (2) effects on enrollment of eligible, but not enrolled, children; (3) states' level of interest in using ELE particularly for implementing PPACA; and (4) uncertainty regarding the potential for erroneous excess payments for children enrolled through ELE.Available information reg...
Medicaid: More Transparency of and Accountability for Supplemental Payments Are Needed
GAO-13-48: Published: Nov 26, 2012. Publicly Released: Dec 21, 2012.
The recently implemented annual audits and reports for states' disproportionate share hospital (DSH) payments could improve oversight by the Centers for Medicare & Medicaid Services (CMS)--the federal agency that oversees Medicaid--by illuminating needed changes. States are required to submit audits and reports to CMS as a condition for receiving federal funds for their DSH payments. The first set...
CMS Innovation Center: Early Implementation Efforts Suggest Need for Additional Actions to Help Ensure Coordination with Other CMS Offices
GAO-13-12: Published: Nov 15, 2012. Publicly Released: Dec 17, 2012.
From the time it became operational in November 2010, through March 31, 2012, the Center for Medicare and Medicaid Innovation (Innovation Center) has focused on implementing 17 new models to test different approaches for delivering or paying for health care in Medicare and Medicaid. The center is still relatively early in the process of implementing these models. Eleven of the models were selected...
Electronic Health Records: Number and Characteristics of Providers Awarded Medicaid Incentive Payments for 2011
GAO-13-146R: Published: Dec 13, 2012. Publicly Released: Dec 13, 2012.
In summary, 1,964 hospitals and 45,962 professionals were awarded a total of approximately $2.7 billion in Medicaid EHR incentive payments for 2011. These 1,964 hospitals, which represented 39 percent of the 5,013 eligible hospitals, were awarded a total of $1.7 billion in Medicaid EHR incentive payments for 2011. While the amount of Medicaid EHR incentive payments awarded to each hospital ranged...
Medicaid Integrity Program: CMS Should Take Steps to Eliminate Duplication and Improve Efficiency
GAO-13-50: Published: Nov 13, 2012. Publicly Released: Dec 10, 2012.
The Medicaid Integrity Group's (MIG) hiring of separate review and audit contractors for its National Medicaid Audit Program (NMAP) was inefficient and led to duplication because key functions were performed by both entities. Review contractors analyze state claims data to identify aberrant claims or billing anomalies while audit contractors conduct postpayment audits to determine if payments to p...
Medicare Program Integrity: Greater Prepayment Control Efforts Could Increase Savings and Better Ensure Proper Payment
GAO-13-102: Published: Nov 13, 2012. Publicly Released: Dec 10, 2012.
Use of prepayment edits saved Medicare at least $1.76 billion in fiscal year 2010, but GAO found that savings could have been greater had prepayment edits been more widely used. GAO illustrated this point using analysis of a limited number of national policies and local coverage determinations (LCD), which are established by each Medicare administrative contractor (MAC) to specify coverage rules i...
Medicare and Medicaid: Consumer Protection Requirements Affecting Dual-Eligible Beneficiaries Vary across Programs, Payment Systems, and States
GAO-13-100: Published: Dec 5, 2012. Publicly Released: Dec 5, 2012.
Medicare and Medicaid consumer protection requirements vary across programs, payment systems--either fee-for-service (FFS) or managed care--and states. Within Medicare, enrollment in managed care through the Medicare Advantage (MA) program must always be voluntary, whereas state Medicaid programs can require enrollment in managed care in certain situations. For example, Arizona requires nearly all...