Open Recommendations (141 total)

Medicaid: CMS Needs to Implement Risk-Based Oversight of Puerto Rico's Procurement Process

Show
1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should take steps to implement ongoing, risk-based oversight of Medicaid procurement processes in Puerto Rico; such actions could include performing an assessment of competitive and noncompetitive procurement processes to identify risks and address them by promoting competition, as appropriate for the efficient operation of the Medicaid program. (Recommendation 1)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Federal Rulemaking: Selected EPA and HHS Regulatory Analyses Met Several Best Practices, but CMS Should Take Steps to Strengthen Its Analyses

Show
1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of the Centers for Medicare & Medicaid Services should take steps to ensure future regulatory analyses are consistent with best practices, particularly with regard to (1) analyzing alternatives, (2) assessing important effects, and (3) ensuring analytical transparency. (Recommendation 1)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicaid: CMS Needs More Information on States' Financing and Payment Arrangements to Improve Oversight

Show
1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should collect and document complete and consistent provider-specific information about Medicaid payments to providers, including new state-directed managed care payments, and states' sources of funding for the nonfederal share of these payments. (Recommendation 1)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

COVID-19: Urgent Actions Needed to Better Ensure an Effective Federal Response

Show
1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of the Centers for Medicare & Medicaid Services should quickly develop a plan that further details how the agency intends to respond to and implement, as appropriate, the 27 recommendations in the final report of the Coronavirus Commission on Safety and Quality in Nursing Homes, which the Centers for Medicare & Medicaid Services released on September 16, 2020. Such a plan should include milestones that allow the agency to track and report on the status of each recommendation; identify actions taken and planned, including areas where the Centers for Medicare & Medicaid Services determined not to take action; and identify areas where the agency could coordinate with other federal and nonfederal entities. (Recommendation 2)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

HHS neither agreed nor disagreed with our recommendation. HHS officials highlighted actions that CMS has taken related to Commission recommendations and said it would refer to and act upon the Commission's recommendations, as appropriate. As of February 2021, CMS had no additional updates. We maintain that developing a plan that details how CMS will proceed with remaining recommendations, includes milestones, and demonstrates that coordination with other federal and nonfederal stakeholders would improve CMS's ability to systematically consider the Commission's recommendations going forward.

Medicaid Long-Term Services and Supports: Access and Quality Problems in Managed Care Demand Improved Oversight

Show
2 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should develop and implement a national strategy for monitoring MLTSS programs and ensuring that states and MCOs resolve identified problems. Among other things, this strategy should address state implementation of beneficiary protection and monitoring requirements. (Recommendation 1)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

CMS did not concur with our recommendation and did not report taking any actions as of March, 2021. We will continue to monitor any actions the agency has taken in response to this recommendation, and will provide updates as needed.
Centers for Medicare and Medicaid Services The Administrator of CMS should assess the nature and prevalence of MLTSS access and quality problems across states. (Recommendation 2)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

CMS did not concur with our recommendation and did not report taking any actions as of March, 2021. We will continue to monitor any actions the agency has taken in response to this recommendation, and will provide updates as needed.

Medicaid Program Integrity: Action Needed to Ensure CMS Completes Financial Management Reviews in a Timely Manner

Show
1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should develop and implement time frames to ensure that the agency completes FMRs in a timely manner. (Recommendation 1)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicaid Information Technology: Effective CMS Oversight and States' Sharing of Claims Processing and Information Retrieval Systems Can Reduce Costs

Show
3 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should encourage state Medicaid program officials to consider involving state CIOs in overseeing Medicaid IT projects. (Recommendation 6)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

In March 2021, CMS officials stated that as part of their APD approval process, the agency works with states to ensure that they have the appropriate technology leadership and business sponsorship in place for their significant IT development efforts. However, the CMS officials did not state how they would implement the recommendation to encourage states to involve state CIOs in overseeing Medicaid IT projects. GAO will continue to monitor the implementation of this recommendation.
Centers for Medicare and Medicaid Services The Administrator of CMS should require analysts to maintain relevant MMIS and E&E system artifacts based on the entire system life cycle instead of individual APDs. (Recommendation 4)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

As of March 2021, GAO verified that CMS developed standard operating procedures that required reviewers to maintain all APD-related artifacts within its document management system. However, CMS did not provide evidence regarding how the reviewers are to maintain relevant MMIS and E&E system artifacts based on the entire system life cycle within the document management system. GAO will continue to monitor the implementation of this recommendation.
Centers for Medicare and Medicaid Services Prior to approving funding for MMIS and E&E systems, the Administrator of CMS should identify areas of duplication or common functionality, such as core MMIS modules, in order to facilitate sharing, leveraging, or reusing Medicaid technologies. CMS should share the results of the review with the state or territory requesting federal funding for a duplicative or similar project and take steps to encourage states to share, leverage, or reuse Medicaid technologies, where possible. (Recommendation 9)
Open

Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

In March 2021, HHS officials stated that CMS had taken initial actions to address GAO's recommendation, including formalizing a communication strategy for meetings with major vendors to discuss strategies as it relates to CMS priorities, duplication of effort, and reuse of systems with states. In addition, HHS stated that it has initiated ongoing communities of practice that are available to all states. These communities of practice, according to HHS, enable states and CMS to share best practices and showcase opportunities for reuse among states. HHS stated that it plans to update its regulations and promote reuse by strengthening the reuse condition for enhanced federal funding. GAO will continue to monitor the implementation of this recommendation.