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    Subject Term: "Cost sharing (finance)"

    6 publications with a total of 13 open recommendations including 6 priority recommendations
    Director: Katherine Iritani
    Phone: (202) 512-7114

    2 open recommendations
    including 2 priority recommendations
    Recommendation: To promote consistency in the distribution of supplemental payments among states and with CMS policy, the Administrator of CMS should issue written guidance clarifying its policy that requires a link between the distribution of supplemental payments and the provision of Medicaid-covered services.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: As of December 2017, the Centers for Medicare & Medicaid Services (CMS) had issued clarifying letters to some states, but had no plans to issue written guidance to all states clarifying that the distribution of supplemental payments be linked to the provision of Medicaid-covered services, as GAO recommended in February 2016. CMS stated in November 2017 that it was considering a proposed rule or other guidance to address this issue. To the extent that the agency's efforts link individual provider payment levels and the provision of Medicaid-covered services, they would address this recommendation.
    Recommendation: To promote consistency in the distribution of supplemental payments among states and with CMS policy, the Administrator of CMS should issue written guidance clarifying its policy that payments should not be made contingent on the availability of local funding.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: As of December 2017, CMS had not issued written guidance to communicate its policy that Medicaid payments may not be made contingent on the availability of local funding for the nonfederal share, as GAO recommended in February 2016. In light of GAO's finding that, among selected states, supplemental payments were often contingent on the availability of local funding, GAO maintains that CMS should issue written guidance to all states communicating its policy prohibiting Medicaid payments contingent on the availability of local funding. Such action could help curtail the practice of states making large supplemental payments in excess of costs.
    Director: Lori Rectanus
    Phone: (202) 512-2834

    2 open recommendations
    Recommendation: To improve cost sharing for dam safety repairs, the Secretary of Defense should direct the Secretary of the Army to direct the Chief of Engineers and Commanding General of the U.S. Army Corps of Engineers to clarify policy guidance on the types of circumstances under which the state-of-the-art provision of the Dam Safety Assurance authority might apply to dam safety repair projects.

    Agency: Department of Defense
    Status: Open

    Comments: As of June 2017, the Assistant Secretary of the Army for Civil Works (ASA(CW)) has begun efforts to clarify policy guidance on usage of the state-of-the-art provision. GAO will continue to monitor ASA(CW) progress in this regard.
    Recommendation: To improve cost sharing for dam safety repairs, the Secretary of Defense should direct the Secretary of the Army to direct the Chief of Engineers and Commanding General of the U.S. Army Corps of Engineers to clarify policy guidance for district offices to effectively communicate with sponsors to establish and implement cost sharing agreements during dam safety repair projects. For all dams, including the three dams named in the report, this would involve communicating estimated and final cost sharing amounts, executing agreements, and engaging sponsors to ensure cost share payment.

    Agency: Department of Defense
    Status: Open

    Comments: As of June 2017, the Assistant Secretary of the Army for Civil Works (ASA(CW)) has begun efforts to review and clarify policy, guidance, and business practices related to communication with all stakeholders regarding the Army Corps of Engineers' (Corps) major rehabilitation and dam safety repair work. ASA(CW) is confident that these efforts will ensure those entities that are required to pay a portion of the cost of such work, or reimburse the U.S. Treasury Department, execute agreements for this payment or reimbursement prior to the initiation of any major rehabilitation or dam safety repair, with the exception of work needed to address emergency situations. With respect to water supply sponsors at the dams named in our report--Tuttle Creek Dam (KS), Rough River Dam (KY), Center Hill Dam TN)--the ASA(CW) will engage with current sponsors to establish a path forward for recouping Federal investment in the Corps' work, including finalizing cost sharing agreements. GAO will continue to monitor ASA(CW) progress in completing these actions.
    Director: Carolyn L. Yocom
    Phone: (202) 512-7114

    2 open recommendations
    including 2 priority recommendations
    Recommendation: To improve the effectiveness of its oversight of eligibility determinations, the Administrator of CMS should conduct reviews of federal Medicaid eligibility determinations to ascertain the accuracy of these determinations and institute corrective action plans where necessary.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: The Department of Health and Human Services (HHS) has taken some steps to improve the accuracy of Medicaid eligibility determinations, as GAO recommended in October 2015, but has not conducted a systematic review of federal eligibility determinations. In March 2017, HHS reported that it is reviewing federal determinations of Medicaid eligibility in two of the nine states that have delegated eligibility determination authority to the federal marketplace and HHS is planning to include reviews of federal determinations as part of its future Payment Error Rate Measurement (PERM) reviews, which will resume in 2018 pending final publication of the proposed PERM rule (81 FR 40596). In October 2016, HHS officials provided information indicating that the Department is relying upon operational controls within federally marketplaces to ensure accurate eligibility determinations as well as new processes that would identify duplicate coverage. These actions have value, however, they are not sufficient to identify other types of erroneous eligibility determinations. Without a systematic review of federal eligibility determinations, HHS lacks a mechanism to identify and correct errors and associated payments.
    Recommendation: To increase assurances that states receive an appropriate amount of federal matching funds, the Administrator of CMS should use the information obtained from state and federal eligibility reviews to inform the agency's review of expenditures for different eligibility groups in order to ensure that expenditures are reported correctly and matched appropriately.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: As of April 2017, HHS is establishing a process to make the eligibilty and expenditure reviews interact with one another. GAO will work with the agency to determine if these actions address the recommendation.
    Director: Katherine M. Iritani
    Phone: (202) 512-7114

    3 open recommendations
    including 2 priority recommendations
    Recommendation: To improve CMS's oversight of Medicaid payments, the Administrator of CMS should take steps to ensure that states report accurate provider-specific payment data that include accurate unique national provider identifiers (NPI).

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: As of December 2017, CMS was developing a query to summarize payment information by state, including data on the National Payment Identifiers--unique 10-digit identification numbers assigned to health care providers--in the federal system states use to submit claims information to CMS. The agency has not determined an expected completion date. To the extent CMS's efforts result in states reporting accurate information on supplemental payments made to individual providers that can be combined with information states submit on their regular payments made to individual providers, it will improve CMS's ability to determine the total amount of Medicaid payments to individual providers. GAO plans to continue to monitor CMS efforts.
    Recommendation: To improve CMS's oversight of Medicaid payments, the Administrator of CMS should develop a policy establishing criteria for when such payments at the provider level are economical and efficient.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: As of December 2017, CMS was considering but had not developed new supplemental payment guidance. To the extent CMS's efforts result in criteria for determining the economy and efficiency of payments to individual providers, it will improve the agency's ability to identify excessive payment. GAO plans to continue to monitor CMS efforts
    Recommendation: To improve CMS's oversight of Medicaid payments, the Administrator of CMS should, once criteria are developed, develop a process for identifying and reviewing payments to individual providers in order to determine whether they are economical and efficient.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open
    Priority recommendation

    Comments: As of December 2017, CMS was considering but had not developed guidance to address this recommendation. To the extent CMS issues additional guidance that results in a review process of payments made to individual providers in conjunction with criteria to determine economy and efficiency of payments, it will enhance CMS's ability to identify and curtail excessive payments in a systematic manner across all states. GAO plans to continue to monitor CMS efforts.
    Director: Dave Wise
    Phone: (202) 512-2834

    3 open recommendations
    Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and complete and publish a new or updated strategic plan that, among other things, clearly outlines a strategy for addressing NEMT and how it can be coordinated across federal agencies that fund NEMT service.

    Agency: Department of Transportation
    Status: Open

    Comments: The Federal Transit Administration (FTA) concurred with this recommendation. As of November 2016, FTA stated that Administrator-level members of the Coordinating Council on Access and Mobility (CCAM) met in July 2016 to begin the process of developing a strategic plan. A follow-up meeting of the same group is planned for December 2016. According to FTA, it is anticipated this meeting will result in agreement on a strategic plan framework and that interagency working groups will begin implementation of the framework in early 2017. Based on the minutes of the July 2016 CCAM meeting, emerging themes identified for the strategic plan included improved access to medical care and to better coordinate transportation planning, particularly integrating transportation planning into healthcare planning. This recommendation will be kept open pending finalization of the strategic plan framework and how it relates to NEMT.
    Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and finalize and issue a cost-sharing policy and clearly identify how it can be applied to programs under the purview of member agencies of the Coordinating Council that provide funding for NEMT.

    Agency: Department of Transportation
    Status: Open

    Comments: FTA concurred with this recommendation. As of November 2016, FTA stated that Administrator-level members of the Coordinating Council on Access and Mobility met in July 2016 to begin the process of developing a strategic plan. A follow-up meeting of the same group is planned for December 2016. According to FTA, it is anticipated the December meeting will result in agreement on a strategic plan framework and that interagency working groups will begin implementing the plan in early 2017. FTA expects development of a cost-sharing policy and proposed model will be an objective in the strategic plan. We plan to keep this recommendation open pending completion of the strategic plan framework and further information related to implementing this recommendation.
    Recommendation: To promote and enhance federal, state, and local NEMT coordination activities, the Secretary of Transportation, as the chair of the Coordinating Council, should convene a meeting of the member agencies of the Coordinating Council and using the on-going work of the Health, Wellness, and Transportation working group and other appropriate resources, (1) identify the challenges associated with coordinating Medicaid and VA NEMT programs with other federal programs that fund NEMT, (2) develop recommendations for how these challenges can be addressed while still maintaining program integrity and fraud prevention, and (3) report these recommendations to appropriate committees of Congress. To the extent feasible, the Coordinating Council should implement those recommendations that are within its legal authority.

    Agency: Department of Transportation
    Status: Open

    Comments: FTA said they concurred in part with this recommendation. FTA announced the selection of 19 Rides to Wellness Demonstration and Innovative Coordinated Access and Mobility pilot projects, totally about $7.3 million, in September 2016. According to FTA, seven of the 19 projects have a NEMT focus. In addition, during 2016 FTA conducted outreach sessions in various cities throughout the United States to discuss partnership opportunities between the health and transportation industries. FTA stated that a new series of NEMT-specific listening sessions is now underway and additional sessions are planned for 2017. The purpose of these sessions is to identify challenges related to NEMT coordination that will be addressed by Coordinating Council on Access and Mobility (CCAM) working groups in the future. CCAM is also in the process of developing a strategic plan framework. FTA anticipates agreement on this framework in December 2016. The Fixing America's Surface Transportation (FAST) Act requires CCAM to develop and publish a strategic plan. FTA anticipates issues related to this recommendation will be developed through 2020. We plan to keep this recommendation open to further monitor CCAM and FTA progress and the extent challenges are identified and addressed related to better coordinating Medicaid and VA NEMT with other NEMT programs in the federal government, through the strategic plan framework or other actions resulting from the listening sessions.
    Director: Katherine M. Iritani
    Phone: (202) 512-7114

    1 open recommendations
    Recommendation: The Administrator of CMS should develop a data collection strategy that ensures that states report accurate and complete data on all sources of funds used to finance the nonfederal share of Medicaid payments. There are short- and long-term possibilities for pursuing the data collection strategy, including (1) in the short-term, as part of its ongoing initiative to annually collect data on Medicaid payments made to hospitals, nursing facilities, and other institutional providers, CMS could collect accurate and complete facility-specific data on the sources of funds used to finance the nonfederal share of the Medicaid payments, and (2) in the long-term, as part of its ongoing initiative to develop an enhanced Medicaid claims data system (T-MSIS), CMS could ensure that T-MSIS will be capable of capturing information on all sources of funds used to finance the nonfederal share of Medicaid payments, and, once the system becomes operational, ensure that states report this information for supplemental Medicaid payments and other highrisk Medicaid payments.

    Agency: Department of Health and Human Services: Centers for Medicare and Medicaid Services
    Status: Open

    Comments: As of December 2017, CMS has not developed a data collection strategy to ensure states report accurate and complete data on all sources of funds used to finance the nonfederal share of Medicaid payments. CMS officials reported that the agency has started to collect state-submitted information through T-MSIS about the source of funds used to finance the nonfederal share of Medicaid payments with the goal of improving funding and payment transparency and to ensure that the sources of funds are in compliance with federal statutory requirements. However, CMS had not yet corrected limitations with the collected data that GAO had identified in its July 2014 report. Further, as of November 2017 the agency had not yet planned specifically how it will use the data it is collecting for oversight and ensure its accuracy and completeness. Agency officials also indicated that the agency was working on guidance related to the oversight of Medicaid supplemental payments and financing issues that could potentially address this recommendation, but there was no timeline for when it would be issued. GAO continues to believe it is important that CMS and federal policymakers have more complete information about how increasing federal costs are impacting the Medicaid program, including beneficiaries and the providers who serve them and plans to continue to monitor CMS's actions to help ensure that states report accurate and complete data on all sources of the nonfederal share.