Health Care 1 Doctor

Health: Medicaid Supplemental Payments (2013-26)

To improve the transparency of and accountability for certain high-risk Medicaid payments that annually total tens of billions of dollars, Congress should consider requiring the Centers for Medicare & Medicaid Services to take steps that would facilitate the agency’s ability to oversee these payments, including identifying payments that are not used for Medicaid purposes or are otherwise inconsistent with Medicaid payment principles, which could lead to cost savings. GAO’s analysis of providers for which data are available suggests that savings could be in the hundreds of millions, or billions, of dollars.

Year Identified: 2013
Area Number: 26
Area Type: Cost Savings & Revenue Enhancement

3 Total Action(s)

Action 1
Addressed

Congress should consider requiring the Administrator of the Centers for Medicare & Medicaid Services (CMS) to improve state reporting of non-Disproportionate Share Hospital (DSH) supplemental payments, including requiring annual reporting of payments made to individual facilities and other information that the agency determines is necessary to oversee non-DSH supplemental payments.

Type
Congressional
Last Updated
August 31, 2021
Progress:

In December 2020, Congress passed and the President signed into law legislation requiring additional state reporting on Medicaid non-DSH supplemental payments, as GAO suggested in November 2012. The annual reports are to include a comprehensive description of the methodology used to calculate the amount of, and to distribute, the payments to each eligible provider, among other things. The enhanced state reporting should enable CMS to improve oversight of these payments, which could result in financial savings to Medicaid to the extent that CMS identifies inappropriate payments and curtails states' ability to make them.

Implementing Entity:
Congress
Action 2
Addressed

Congress should consider requiring the Administrator of the Centers for Medicare & Medicaid Services (CMS) to clarify permissible methods of calculating non-Disproportionate Share Hospital (DSH) supplemental payments.

Type
Congressional
Last Updated
August 31, 2021
Progress:

In December 2020, Congress passed and the President signed into law legislation requiring additional state reporting on Medicaid non-DSH supplemental payments, as GAO suggested in November 2012. The annual reports are to include a description of how these payments are consistent with economy and efficiency, and the criteria used to determine which providers are eligible to receive these payments, among other things. The enhanced state reporting should enable CMS to improve oversight of these payments, which could result in financial savings to Medicaid to the extent that CMS identifies inappropriate payments and curtails states' ability to make them.

Implementing Entity:
Congress
Action 3
Not Addressed

Congress should consider requiring the Administrator of the Centers for Medicare & Medicaid Services (CMS) to require states to submit an annual independent certified audit verifying state compliance with permissible methods for calculating non-Disproportionate Share Hospital (DSH) supplemental payments.

Type
Congressional
Last Updated
March 31, 2022
Progress:

No legislative action taken as of March 2022. In February 2022, CMS officials said that legislation is needed to require states to submit annual independent certified audits verifying compliance with permissible methods for calculating non-DSH supplemental payments, as GAO suggested in November 2012. GAO maintains that long-standing concerns are still valid regarding the need for improved transparency and accountability for Medicaid supplemental payments, including annual independent certified audits of the methods for calculating non-DSH supplemental payments. Annual independent certified audits could help CMS better oversee these payments to ensure they are consistent with Medicaid requirements and result in financial savings to Medicaid to the extent inappropriate payments are identified and states' ability to make them is curtailed.

Implementing Entity:
Congress
GAO Contacts