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    Subject Term: "Medicaid payments"

    4 publications with a total of 7 open recommendations including 5 priority recommendations
    Director: Katherine Iritani
    Phone: (202) 512-7114

    1 open recommendations
    including 1 priority recommendation
    Recommendation: To ensure efficient use of federal resources, the Administrator of CMS should account for Medicaid payments a hospital has received that offset uncompensated care costs when determining hospital uncompensated care costs for the purposes of making Medicare UC payments to individual hospitals.

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

    Comments: The Centers for Medicare & Medicaid Services (CMS) concurred with this recommendation in June 2016, but stated in December 2017 that it was unclear whether it was appropriate to account for Medicaid uncompensated care payments that hospitals received when determining uncompensated care costs for purposes of making Medicare Uncompensated Care payments. GAO maintains that accounting for Medicaid payments when determining hospital uncompensated care costs is needed. Without accounting for the payments, CMS is at risk of making Medicare uncompensated care payments to hospitals that do not have any uncompensated care costs.
    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: 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: 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.