Health insurance cost control (11 - 20 of 130 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...
Medicaid Waivers: HHS Approvals of Pharmacy Plus Demonstrations Continue to Raise Cost and Oversight Concerns
GAO-04-480: Published: Jun 30, 2004. Publicly Released: Jul 30, 2004.
Under section 1115 of the Social Security Act, the Secretary of Health and Human Services may waive certain Medicaid requirements for states seeking to deliver services through demonstration projects. By policy, these demonstrations must not increase federal spending. GAO has previously reported concerns with HHS's approval process. GAO was asked to provide information on a new Medicaid section 11...
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: Orthotics Ruling Has Implications for Beneficiary Access and Federal and State Costs
GAO-02-330: Published: May 22, 2002. Publicly Released: May 22, 2002.
In the late 1980s and early 1990s, the Health Care Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), became concerned that some suppliers were improperly billing Medicare for items that attach to wheelchairs and other equipment. Some suppliers were billing for such items using codes for orthodic devices, including arm, back, and neck braces that prov...
Medigap: Current Polices Contain Coverage Gaps, Undermine Cost Control Incentives
GAO-02-533T: Published: Mar 14, 2002. Publicly Released: Mar 14, 2002.
Medicare provides valuable and extensive health care coverage for 40 million elderly and disabled beneficiaries. Nevertheless, significant gaps leave some beneficiaries vulnerable to sizeable out-of-pocket expenses. Medicare provides no limit on out-of-pocket spending and no coverage for most outpatient prescription drugs. Most beneficiaries have supplemental coverage that helps to fill Medicare c...
Retiree Health Insurance: Gaps in Coverage and Availability
GAO-02-178T: Published: Nov 1, 2001. Publicly Released: Nov 1, 2001.
In 1999, about 10 million Americans aged 55 and older relied on employer-sponsored health benefits until they became eligible for Medicare or to pay for out-of-pocket expenses not covered by Medicare. However, the number of employers offering these benefits has declined considerably during the past decade. Despite the recent strong economy and the relatively low increases in health insurance premi...
Children's Health Insurance: SCHIP Enrollment and Expenditure Information
GAO-01-993R: Published: Jul 25, 2001. Publicly Released: Sep 6, 2001.
Congress created the State Children's Health Insurance Program (SCHIP) in 1997 to reduce the number of uninsured poor children whose families incomes are too high to qualify for Medicaid. Congress appropriated $40 billion over 10 years (fiscal years 1998 through 2007) for SCHIP. Each state's SCHIP allotment is available as a federal match based on state expenditures. Although the SCHIP statute gen...
Medicare Management: CMS Faces Challenges to Sustain Progress and Address Weaknesses
GAO-01-817: Published: Jul 31, 2001. Publicly Released: Aug 31, 2001.
Considering the complexity, the size, and the statutory constraints affecting the Medicare Program, some contend that the Health Care Financing Administration's (HCFA)--recently renamed the Centers for Medicare and Medicaid Services--management of Medicare has, on balance, been satisfactory. Others argue that HCFA's management has been unacceptable. HCFA's record has been mixed and the agency's ch...
Health Centers and Rural Clinics: Payments Likely to Be Constrained Under Medicaid's New System
GAO-01-577: Published: Jun 19, 2001. Publicly Released: Jun 21, 2001.
To increase the accessibility of primary and preventive health services for low-income people living in medically underserved areas, Congress made federally qualified health centers and rural health clinics eligible for Medicaid payments. Since 1989, federal law has required Medicaid to reimburse both the centers and the clinics on the basis of reasonable costs they incurred in providing services...
Medicare Management: Current and Future Challenges
GAO-01-878T: Published: Jun 19, 2001. Publicly Released: Jun 19, 2001.
Medicare is a popular program that millions of Americans depend on for covering their essential health needs. However, the management of the program has fallen short of expectations because it has not always appropriately balanced or satisfied the needs of beneficiaries, providers, and taxpayers. For example, stakeholders expect that Medicare will price services prudently; that providers will be t...