Centers for Medicare & Medicaid Services

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Open Recommendations (129 total)

Medicare Advantage: Plans Generally Offered Some Supplemental Benefits, but CMS Has Limited Data on Utilization

GAO-23-105527
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2 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should clarify guidance to MA plans on the extent to which encounter data submissions must include data on the utilization of supplemental benefits. (Recommendation 1)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Centers for Medicare & Medicaid Services The Administrator of CMS should take actions to address circumstances where submitting encounter data for supplemental benefits is challenging for MA plans, such as when a given benefit lacks an applicable procedure code. Such actions may include the creation of new procedure codes or a new data submission format. (Recommendation 2)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Nursing Homes: CMS Should Make Ownership Information More Transparent for Consumers

GAO-23-104813
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services CMS should fully align the nursing home ownership information on the Care Compare website with the relevant characteristics of effective transparency tools. This should include, for example, the following:

  • Using plain language to define key terms in the ownership section of Care Compare.
  • Organizing ownership information by providing consumers easy access to a list of all facilities under common ownership, their respective star ratings, and a distribution of star ratings across nursing homes with common ownership to allow consumers to examine quality patterns across such facilities. (Recommendation 1.)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicare: CMS Needs to Address Risks Posed by Provider Enrollment Waivers and Flexibilities

GAO-23-105494
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4 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should develop and implement a plan for conducting provider enrollment revalidations to ensure providers are revalidated prior to the end of their 3- to 5-year revalidation cycles, prioritizing moderate- and high-risk provider types. (Recommendation 3)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Centers for Medicare & Medicaid Services The Administrator of CMS should conduct fingerprint-based criminal background checks for high-risk provider types who enrolled during the COVID-19 public health emergency, such as when CMS revalidates these providers' information. (Recommendation 1)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Centers for Medicare & Medicaid Services The Administrator of CMS should evaluate waivers and flexibilities for provider enrollment, including related oversight challenges, and address any opportunities for improvement. This evaluation could consider targeting provider enrollment waivers and flexibilities to maintain requirements for provider types CMS considers high risk—including DMEPOS suppliers—and opportunities to track and communicate to program integrity contractors information about each waiver and flexibility providers enrolled under. (Recommendation 4)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Centers for Medicare & Medicaid Services The Administrator of CMS should develop policies and procedures to postpone rather than waive fingerprint-based criminal background checks during future emergencies. (Recommendation 2)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Abuse and Neglect: CMS Should Strengthen Reporting Requirements to Better Protect Individuals Receiving Hospice Care

GAO-23-105463
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The CMS administrator should require, for individuals in hospice care, immediate reporting of all abuse and neglect allegations involving all perpetrators—including those not affiliated with the hospice—to the hospice administrator, a state survey agency, and other appropriate authorities. (Recommendation 1)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicare Telehealth: Actions Needed to Strengthen Oversight and Help Providers Educate Patients on Privacy and Security Risks

GAO-22-104454
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2 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should comprehensively assess the quality of Medicare services, including audio-only services, delivered using telehealth during the public health emergency. Such an assessment could include leveraging evidence from related efforts led by other HHS agencies. (Recommendation 3)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
In November 2022, CMS said they no longer agree with this recommendation because they do not have a measure to assess quality, and cannot consider developing or re-specifying such a measure due to budget restraints. Further, they have no planned actions for this recommendation. We maintain the importance of assessing the quality of telehealth services given that providers receive the same payment whether or not telehealth services are provided via video or audio-only during the public health emergency. Also, it is important for CMS to study the quality of telehealth services to ensure that services are medically necessary, equitable, and lead to improved health outcomes.
Centers for Medicare & Medicaid Services The Administrator of CMS should develop an additional billing modifier or clarify its guidance regarding billing of audio-only office visits to allow the agency to fully track these visits. (Recommendation 1)
Open

 Actions to satisfy the intent of the recommendation have not been taken or are being planned.
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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