Managed health care (31 - 40 of 157 items)
Medicaid: Federal Oversight of Payments and Program Integrity Needs Improvement
GAO-12-674T: Published: Apr 25, 2012. Publicly Released: Apr 25, 2012.
Oversight of managed care rate-setting has been inconsistent. In August 2010, GAO reported that the Centers for Medicare & Medicaid Services (CMS) had not ensured that all states were complying with the managed care actuarial soundness requirements that rates be developed in accordance with actuarial principles, appropriate for the population and services, and certified by actuaries. For example,...
Drug Pricing: Research on Savings from Generic Drug Use
GAO-12-371R: Published: Jan 31, 2012. Publicly Released: Mar 1, 2012.
Our review identified articles that used varying approaches to estimate the savings associated with generic drug use in the United States. One group of studies estimated the savings in reduced drug costs that have accrued from the use of generics. For example, a series of studies estimated the total savings that have accrued to the U.S. health care system from substituting generic drugs for their...
Medicaid and CHIP: Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty Care
GAO-11-624: Published: Jun 30, 2011. Publicly Released: Jun 30, 2011.
Medicaid and the Children's Health Insurance Program (CHIP)--two joint federal-state health care programs for certain low-income individuals--play a critical role in addressing the health care needs of children. The Children's Health Insurance Program Reauthorization Act of 2009 required GAO to study children's access to care under Medicaid and CHIP, including information on physicians' willingnes...
Medicaid and CHIP: Reports for Monitoring Children's Health Care Services Need Improvement
GAO-11-293R: Published: Apr 5, 2011. Publicly Released: Apr 5, 2011.
Medicaid and the Children's Health Insurance Program (CHIP)--two joint federal-state health care programs for low-income families and children--play a critical role in addressing the health care needs of children. In 2008, more than 36 million children in the United States received health care coverage through Medicaid or CHIP. Like all children, children covered by Medicaid and CHIP may have heal...
Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement
GAO-10-810: Published: Aug 4, 2010. Publicly Released: Aug 4, 2010.
Medicaid managed care rates are required to be actuarially sound. A state is required to submit its rate-setting methodology, including a description of the data used, to the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) for approval. The Children's Health Insurance Program Reauthorization Act of 2009 required GAO to examine the extent to which state...
Medicaid: CMS Needs More Information on the Billions of Dollars Spent on Supplemental Payments
GAO-08-614: Published: May 30, 2008. Publicly Released: Jun 30, 2008.
The financing of the $299 billion Medicaid program is shared between the federal government and states. States pay qualified providers for covered Medicaid services and receive federal matching funds from the Department of Health & Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) for expenditures authorized in their state Medicaid plans. In addition to these standard Medicaid p...
Medicaid: Thousands of Medicaid Providers Abuse the Federal Tax System
GAO-08-17: Published: Nov 14, 2007. Publicly Released: Nov 14, 2007.
In fiscal year 2006, outlays for Medicaid were about $324 billion; about $185 billion was paid by the federal government. Because GAO previously identified abusive and criminal activity associated with government contractors owing billions of dollars in federal taxes, the subcommittee requested GAO expand our work to Medicaid providers. GAO was asked to (1) determine if Medicaid providers have unp...
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 Savings Programs: Results of Social Security Administration's 2002 Outreach to Low-Income Beneficiaries
GAO-04-363: Published: Mar 26, 2004. Publicly Released: Mar 26, 2004.
To assist low-income beneficiaries with their share of premiums and other out-of-pocket costs associated with Medicare, Congress has created four Medicare savings programs. Historic low enrollment in these programs has been attributed to several factors, including lack of awareness about the programs, and cumbersome eligibility determination and enrollment processes through state Medicaid programs...