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Centers for Medicare & Medicaid Services

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Open Recommendations (118 total)

Medicare Hospice: CMS Needs to Fully Implement Statutory Provisions and Prioritize Certain Overdue Surveys

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4 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The CMS Administrator should instruct SAs and AOs to prioritize the completion of standard surveys for hospices that are overdue for a survey based on potential risk factors, which could include the amount of time overdue or evidence of past quality issues. (Recommendation 4)
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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 CMS Administrator should make hospice survey results publicly available on Care Compare such that the information is prominent, easily accessible, and readily understandable. (Recommendation 2)
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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 CMS Administrator should fully implement efforts to measure and reduce inconsistency in survey results among all surveyors, including SAs and AOs. (Recommendation 3)
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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 CMS Administrator should fully implement the new enforcement tools, including issuing planned internal guidance, to enable the agency to use these tools to address hospices out of compliance with Medicare quality standards. (Recommendation 1)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicaid Managed Care: Additional Federal Action Needed to Fully Leverage New Appeals and Grievances Data

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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should require states to report on the outcomes of Medicaid managed care appeals (e.g., the extent to which they were decided in favor of enrollees) and number of denials. (Recommendation 1)
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When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicaid Managed Care: Additional Federal Action Needed to Fully Leverage New Appeals and Grievances Data

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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should implement its planned actions for analyzing the Medicaid managed care appeals and grievances data, using it for oversight, and making it publicly available. (Recommendation 2)
Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Medicaid Managed Care: Rapid Spending Growth in State Directed Payments Needs Enhanced Oversight and Transparency

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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should require states to consider health equity priorities in designing evaluations of state directed payments. (Recommendation 3)
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As of April 2024, GAO continues to monitor CMS progress toward implementing this recommendation.

Medicaid Managed Care: Rapid Spending Growth in State Directed Payments Needs Enhanced Oversight and Transparency

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3 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare & Medicaid Services The Administrator of CMS should enhance the agency's fiscal guardrails for approving state directed payments by establishing a definition of, and standards for, assessing whether directed payments result in payment rates that are reasonable and appropriate, and communicating those to states; determining whether additional limits are needed; and requiring states to submit data on actual spending amounts at renewal. (Recommendation 1)
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As of April 2024, GAO continues to monitor CMS progress toward implementing this recommendation.
Centers for Medicare & Medicaid Services The Administrator of CMS should make publicly available all approval documents related to new and renewed state directed payments, including application attachments, state evaluation plans, and evaluation results. (Recommendation 4)
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As of April, GAO continues to monitor CMS progress toward implementing this recommendation.
Centers for Medicare & Medicaid Services The Administrator of CMS should consider interim evaluation results or other performance information from states at renewal to gain more timely information on whether state directed payments are advancing quality goals. (Recommendation 2)
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As of April 2024, GAO continues to monitor CMS progress toward implementing this recommendation.