DOD Health Care: Further Testing and Evaluation of Case-Managed Home Health Care Is Needed
HRD-93-59
Published: May 21, 1993. Publicly Released: May 21, 1993.
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Highlights
Pursuant to a congressional request, GAO provided information on the Department of Defense's (DOD) 1986 and 1988 Civilian Health and Medical Program for the Uniformed Services (CHAMPUS) home care demonstration projects, focusing on: (1) whether the projects yielded sufficient information to adequately identify beneficiaries, prevent program abuse, and determine when and how to provide case management; (2) the reasonableness of CHAMPUS cost savings estimates; and (3) potential overlap between CHAMPUS and the DOD Coordinated Care Program.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | The Secretary of Defense should, before implementing a permanent case-managed home care benefit, evaluate alternative identification methods, such as hospital preadmission certification, to target potential recipients of case-managed home care. |
Closed – Implemented
In October 1995, DOD published its final rule in the Federal Register implementing a permanent case-managed home care benefit, including preauthorization and preadmission screening, continued stay authorization, and retrospective claims analysis. These elements are also part of managed care support contracts now being awarded.
|
| Department of Defense | The Secretary of Defense should, before implementing a permanent case-managed home care benefit, develop specific medical or cost controls to limit access to case-managed home care to patients for whom there is a reasonable likelihood that the care will be cost-effective. |
Closed – Implemented
In October 1995, DOD published its final rule requiring that benefits be certified as medically necessary, appropriate, and cost-effective, with recertification at least every 30 days.
|
| Department of Defense | The Secretary of Defense should, before implementing a permanent case-managed home care benefit, determine: (1) when CHAMPUS case management is needed; (2) when on-site rather than telephone case management is appropriate; and (3) the most efficient way to provide case management services. |
Closed – Implemented
In October 1995, DOD published its final rule identifying varying levels of assistance that beneficiaries may need when accessing health care services through CHAMPUS. DOD's guidance includes criteria for onsite versus telephone case management.
|
| Department of Defense | The Secretary of Defense should, before implementing a permanent case-managed home care benefit, determine how the administration of the CHAMPUS home care benefit fits into the overall DOD Coordinated Care Program. |
Closed – Implemented
In October 1995, DOD published its final rule in the Federal Register authorizing the Director of CHAMPUS to provide case management at medical treatment facilities. The case management benefit will be included as a program requirement within managed care support contracts.
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Cost accounting standards complianceCost effectiveness analysisDefense cost controlHealth care cost controlHealth care programsHealth resources utilizationHome health care servicesInternal controlsMedicaidMedicareProgram abusesMedical care evaluation