Medicare Covered Most New Procedures and Devices: Medicare covered about 99 percent of the procedures and devices that were assigned codes by an American Medical Association panel or a committee of insurers in 2001. About a quarter were introduced into the program without coverage policies that describe the circumstances for Medicare coverage or place restrictions on their use. Another quarter we

To expand the capabilities of the nation's active duty forces, the Department of Defense (DOD) relies on the 1.2 million men and women of the Reserve and National Guard. Currently, reserve components constitute nearly half of the total armed forces. Although DOD requires reservists to use TRICARE DOD's health care system for their own health care, using TRICARE is an option for their dependents.

The Department of Veterans Affairs (VA) runs one of the nation's largest health care systems. In fiscal year 2000, roughly four million patients made 39 million outpatient visits to more than 700 VA health care facilities nationwide. However, excessive waiting times for outpatient care have been a long-standing problem. To ensure timely access to care, VA established a goal that all nonurgent pri

Humana, Inc., a large Medicare Choice Plan, provided a prescription drug benefit with a coverage limit that was below the amount listed in its 1998 Florida Medicare Choice contract. Ernst and Young, the contractor hired by the Health Care Financing Administration (HCFA) to review Humana's contract submission, did not detect the discrepancies because it failed to follow HCFA's review procedures. H

GAO noted that: (1) following the general trend of serving more Medicaid beneficiaries through managed care delivery systems, many states are enrolling a range of children considered to have special needs in capitated managed care programs; (2) however, the number of children involved is uncertain, because many of the states could not readily report the number of affected children; (3) the 36 sta

GAO noted that: (1) processing TRICARE claims costs several times as much as processing Medicare claims--$7.50 compared to $1.78 per claim on average; (2) however, much of the cost difference appears to be attributable to differences in program design and processing requirements; (3) for example, TRICARE offers three different benefit packages, with reimbursement rates that are established for ea

GAO noted that: (1) both the health centers and the Corps are important safety-net providers to the nation's vulnerable populations, but GAO believes certain improvements would enhance the effectiveness of these programs; (2) most health centers continue to be able to serve vulnerable populations, even though a number of significant changes have occurred in the health care environment; (3) HRSA h

GAO noted that: (1) private insurers, managed care plans, and employers have tried to manage the high and rising costs of prescription drugs by adopting cost and utilization control techniques; (2) in many cases, insurers and managed care plans contract with a pharmacy benefit management company (PBM) to develop and implement these strategies; (3) if a prescription drug benefit were added to the

GAO noted that: (1) the various legislative proposals and the Department of Defense's (DOD) fiscal year 2001 budget request offer benefit enhancements much-sought-after and popular with the beneficiaries, but would have limited impact on retention; (2) several would expand or make permanent existing demonstration projects aimed at improving access and pharmacy coverage for older retirees, who hav

GAO noted that: (1) DOD's network adequacy requirements are based on California's Knox-Keene Act, which provides guidelines for health maintenance organizations on numerous aspects of access to care, including network adequacy ratios and the amount of time it takes to drive to a provider's office; (2) in addition to following these standards, most of DOD's managed care support contractors that ad