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Open Recommendations

Defense Health Care: Plans Needed to Ensure Implementation of Required Elements for TRICARE's Managed Care Support Contracts

GAO-20-197
Feb 07, 2020
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1 Open Recommendations
Agency Affected Recommendation Status
Defense Health Agency The Director of DHA should develop and implement plans with timeframes and specific actions needed for all 13 required elements to be reflected in the TRICARE contracts. (Recommendation 1)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

340B Drug Discount Program: Oversight of the Intersection with the Medicaid Drug Rebate Program Needs Improvement

GAO-20-212
Jan 27, 2020
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3 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should ensure that state Medicaid programs have written policies and procedures that specify the extent to which covered entities can use 340B drugs for Medicaid beneficiaries, are designed to effectively identify if 340B drugs were used, and if so, how they should be excluded from Medicaid rebate requests. The policies and procedures should be made publically available and cover FFS, managed care, and all of the dispensing methods for outpatient drugs. (Recommendation 1)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Health Resources and Services Administration The Administrator of HRSA should incorporate assessments of covered entities' compliance with state Medicaid programs' policies and procedures regarding the use and identification of 340B drugs into its audit process, working with CMS as needed to obtain states' policies and procedures. (Recommendation 2)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Health Resources and Services Administration The Administrator of HRSA should require covered entities to work with affected drug manufacturers regarding repayment of identified duplicate discounts in Medicaid managed care. (Recommendation 3)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Opioid Use Disorder: Barriers to Medicaid Beneficiaries' Access to Treatment Medications

GAO-20-233
Jan 24, 2020
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1 Open Recommendations
Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services The Administrator of CMS should determine the extent to which state Medicaid programs are in compliance with federal requirements to cover MAT medications in all formats and take actions to ensure compliance, as appropriate. (Recommendation 1)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

340B Drug Discount Program: Increased Oversight Needed to Ensure Nongovernmental Hospitals Meet Eligibility Requirements

GAO-20-108
Jan 10, 2020
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6 Open Recommendations
Agency Affected Recommendation Status
Health Resources and Services Administration The Administrator of HRSA should ensure that the information it uses to verify nonprofit status for all nongovernmental hospitals that participate in the 340B Program is reliable—for example, by requiring and reviewing the submission of official documentation hospitals must already maintain or by ensuring the reliability of the data the agency uses. (Recommendation 1)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Health Resources and Services Administration The Administrator of HRSA should implement a process to verify that every nongovernmental hospital that participates in the 340B Program has a contract with a state or local government as required by statute. (Recommendation 2)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Health Resources and Services Administration The Administrator of HRSA should amend its contract integrity check procedures for the 340B Program to include a review of whether hospitals' contracts with state and local governments require the provision of health care services to low-income individuals not eligible for Medicaid or Medicare as required by statute, and should provide guidance for staff to conduct these reviews. (Recommendation 3)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Health Resources and Services Administration The Administrator of HRSA should provide more specific guidance for 340B Program auditors on how to determine if nongovernmental hospitals' contracts with state and local governments require the provision of health care services to low-income individuals not eligible for Medicaid or Medicare. (Recommendation 4)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Health Resources and Services Administration The Administrator of HRSA should revise its 340B Program audit procedures to require auditors to document their assessments of whether nongovernmental hospitals' contracts with state and local governments are appropriately signed, cover the time periods under review, and require hospitals to serve low-income individuals not eligible for Medicaid or Medicare, such as by requiring auditors to separately affirm and record their review of each of these elements. (Recommendation 5)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Health Resources and Services Administration The Administrator of HRSA should require nongovernmental hospitals participating in the 340B Program to demonstrate that they have contracts with state or local governments in effect prior to the beginning of their audits' periods of review and should apply consistent and appropriate consequences for hospitals that are unable to do so. (Recommendation 6)
Open

Recommendation status is Open.

When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.