Program management (1 - 10 of 127 items)
Veterans' Health Care: Preliminary Observations on Veterans' Access to Choice Program Care
GAO-17-397T: Published: Mar 7, 2017. Publicly Released: Mar 7, 2017.
The Choice Program allows veterans to obtain health care services outside the Veterans Health Administration if those services are not available or readily accessible within VHA. We found that--if VHA staff and the Choice Program contractors take the maximum amount of time allowed for appointment scheduling--veterans could potentially wait up to 81 calendar days to attend their first appointments...
Foreign Assistance: Agencies Can Improve the Quality and Dissemination of Program Evaluations
GAO-17-316: Published: Mar 3, 2017. Publicly Released: Mar 3, 2017.
An estimated 73 percent of evaluations completed in fiscal year 2015 by the six U.S. agencies GAO reviewed generally or partially addressed all of the quality criteria GAO identified for evaluation design, implementation, and conclusions (see fig.). Agencies met some elements of the criteria more often than others. For example, approximately 90 percent of all evaluations addressed questions that a...
Veterans Crisis Line: Additional Testing, Monitoring, and Information Needed to Ensure Better Quality Service
GAO-16-373: Published: May 26, 2016. Publicly Released: Jun 27, 2016.
GAO found that the Department of Veterans Affairs (VA) did not meet its call response time goals for the Veterans Crisis Line (VCL), although extended call wait times were not common. VA's goal is to answer 90 percent of VCL calls at the VCL primary center within 30 seconds. Currently, calls not answered within 30 seconds route to VCL backup call centers; however, for 5 months of fiscal year 2015,...
Medicaid and CHIP: Increased Funding in U.S. Territories Merits Improved Program Integrity Efforts
GAO-16-324: Published: Apr 8, 2016. Publicly Released: May 9, 2016.
Eligibility and benefits for Medicaid and the state Children's Health Insurance Program (CHIP) in five U.S. territories—American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico and the U. S. Virgin Islands—differ from one another and from the states, generally reflecting the territories' unique circumstances. For example, Guam is the only territory that covers all...
Private Health Insurance: Federal Oversight Premiums and Enrollment for Consumer Operated and Oriented Plans in 2015
GAO-16-326: Published: Mar 10, 2016. Publicly Released: Mar 17, 2016.
The Centers for Medicare & Medicaid Services' (CMS) monitoring of the consumer governed, nonprofit health insurance issuers—known as consumer operated and oriented plans (CO-OPs)—evolved as the CO-OP program matured, and as 12 of the 23 CO-OPs ceased operations on or before January 1, 2016. CMS's initial monitoring activities, starting when it began to award CO-OP program loans in early 2012,...
Medicaid: Key Issues Facing the Program
GAO-15-677: Published: Jul 30, 2015. Publicly Released: Jul 30, 2015.
GAO identified four key issues facing the Medicaid program, based on prior work.Access to care : Medicaid enrollees report access to care that is generally comparable to that of privately insured individuals and better than that of uninsured individuals, but may have greater health care needs and greater difficulty accessing specialty and dental care.Transparency and oversight : The lack of comple...
VA Health Care: Additional Steps Needed to Strengthen Beneficiary Travel Program Management and Oversight
GAO-13-632: Published: Jul 15, 2013. Publicly Released: Jul 15, 2013.
The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) has developed efforts to improve the Beneficiary Travel Program, but lack of internal controls may impede their effectiveness. Specifically, VHA has developed multiple efforts to improve the management and oversight of its process for reimbursing veterans' travel expenses for medical appointments, as well as the timeline...
GAO's 2013 High-Risk Update: Medicare and Medicaid
GAO-13-433T: Published: Feb 27, 2013. Publicly Released: Feb 27, 2013.
Medicare Program: CMS has not met GAO's criteria to have the Medicare program removed from the High-Risk List. For example, although CMS has made progress in measuring and reducing improper payment rates in different parts of the program, it has yet to demonstrate sustained progress in lowering the rates. Because the size of Medicare relative to other programs leads to aggregate improper payments...
Medicare Part D Coverage Gap: Discount Program Effects and Brand-Name Drug Price Trends
GAO-12-914: Published: Sep 28, 2012. Publicly Released: Oct 26, 2012.
As part of Medicare's Part D Coverage Gap Discount Program (Discount Program), the Centers for Medicare & Medicaid Services (CMS), located within the Department of Health and Human Services (HHS), oversees the provision of discounts by plan sponsors to eligible beneficiaries when they purchase brand-name drugs and monitors that discounts are paid for by drug manufacturers. CMS checks prescription...
Medicaid Program Integrity: Expanded Federal Role Presents Challenges to and Opportunities for Assisting States
GAO-12-288T: Published: Dec 7, 2011. Publicly Released: Dec 7, 2011.
The Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid, estimated that improper payments in the federal-state Medicaid program were $21.9 billion in fiscal year 2011. The Deficit Reduction Act of 2005 established the Medicaid Integrity Program and gave CMS an expanded role in assisting and improving the effectiveness of state activities to ensure proper payme...