Open Recommendations (137 total)

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

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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

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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

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1 Open Recommendations
1 Priority
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services
Priority Rec.
This is a priority recommendation.
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.

HHS neither agreed nor disagreed with our recommendation but acknowledged the need for additional state Medicaid financing and payment data to oversee the Medicaid program. HHS also noted that CMS has begun work to improve the collection of financing and payment information through a revised data collection form and that CMS would explore additional actions to do so. In addition, Congress passed and the President signed into law requirements in December 2020 for additional state reporting on Medicaid supplemental payments. To fully implement our recommendation, HHS needs to demonstrate how its ongoing and planned actions in this area, which could include actions in response to the December 2020 law described above, will ensure complete, consistent, and sufficiently documented information about sources of funding for the nonfederal share and payments to providers.

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

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2 Open Recommendations
Agency Affected Recommendation Status
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.
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.

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

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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.

The Department of Health and Human Services (HHS) concurred with this recommendation. In May 2021, HHS reported that the Centers for Medicare & Medicaid Services (CMS) is actively working to establish timeframes and key milestone dates to better track and monitor financial management review (FMR) progress. For example, CMS is establishing FMR field work start and end dates, timeframes and deadlines for states to provide CMS with data and supporting documentation, and timeframes for producing draft and final FMR reports.

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

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4 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.
Centers for Medicare and Medicaid Services The Administrator of CMS should, as part of the APD review process and prior to approval, verify that all of the required information (e.g. alternatives analysis, feasibility study, and cost benefit analysis) is included in the funding request. (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.

As of March 2021, GAO verified that CMS developed standard operating procedures that, as part of the APD review process and prior to approval, required reviewers to verify that certain required information, such as an alternative analysis, was included in the funding request. However, the standard operating procedures did not require CMS to verify that all of the required information, such as the feasibility study and cost benefit analysis, was reviewed and included in the funding request prior to APD approval. GAO will continue to monitor the implementation of this recommendation.