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Medicaid Cms Should Take Steps To Mitigate Program Risks In Managed Care
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Book Synopsis Medicaid: CMS Should Take Steps to Mitigate Program Risks in Managed Care by : United States. Government Accountability Office
Download or read book Medicaid: CMS Should Take Steps to Mitigate Program Risks in Managed Care written by United States. Government Accountability Office and published by . This book was released on 2018 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicaid Managed Care, CMS Should Improve Oversight of Access and Quality in States' Long-term Services and Supports Programs by : United States. Government Accountability Office
Download or read book Medicaid Managed Care, CMS Should Improve Oversight of Access and Quality in States' Long-term Services and Supports Programs written by United States. Government Accountability Office and published by . This book was released on 2017 with total page 39 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis A Health Care Quality Improvement System for Medicaid Managed Care by :
Download or read book A Health Care Quality Improvement System for Medicaid Managed Care written by and published by . This book was released on 1993 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :United States. Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781977516008 Total Pages :44 pages Book Rating :4.5/5 (16 download)
Book Synopsis Medicaid Managed Care by : United States. Government Accountability Office
Download or read book Medicaid Managed Care written by United States. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-09-21 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: Twenty-two states use MLTSS programs to provide care for Medicaid beneficiaries who need long-term support. Using managed care to deliver long-term services and supports can be a strategy for states to expand home- and community-based care, which many beneficiaries prefer, and to lower costs. However, given the potential vulnerability and needs of beneficiaries in these programs, oversight is crucial to ensure their access to quality care. GAO was asked to review states' implementation and CMS's oversight of MLTSS programs. In this report, GAO (1) described how selected states monitored MLTSS access and quality, and (2) examined the extent to which CMS oversees MLTSS access and quality in selected states. GAO reviewed federal regulations, guidance, and internal control standards. For six states selected for variation in location, program size and duration, and other factors, GAO reviewed reporting requirements, reports to CMS, and other documents. GAO also reviewed data from these states on beneficiary appeals and grievances from 2013 through 2015-the most recent data available-and interviewed state and CMS officials.
Author :United States Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781977546791 Total Pages :36 pages Book Rating :4.5/5 (467 download)
Book Synopsis Medicaid Program Integrity by : United States Government Accountability Office
Download or read book Medicaid Program Integrity written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-09-23 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: GAO has reported that Medicaid remains a high-risk program, partly due to concerns about improper payments. Screening of providers is important to help prevent improper payments. Under managed care, states contract with plans to provide services to beneficiaries. GAO was asked to examine the screening of managed care providers. GAO examined (1) states' and plans' experiences using federal databases to screen providers; and (2) how states and plans share data about ineligible providers. GAO interviewed officials from 10 states, selected generally based on enrollment and geography, and representatives from 16 plans from among these states. GAO reviewed those states' Medicaid program websites and plan contracts, and relevant federal laws, regulations, and guidance; and interviewed officials from CMS and the Department of Health and Human Services' Office of Inspector General.
Book Synopsis Managing Accountability in Medicaid Managed Care by :
Download or read book Managing Accountability in Medicaid Managed Care written by and published by . This book was released on 1999 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicaid Managed Care by : United States. Government Accountability Office
Download or read book Medicaid Managed Care written by United States. Government Accountability Office and published by . This book was released on 2010 with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicaid managed care rates are required to be actuarially sound. A state is required to submit its rate-setting methodology, including a description of the data used, to the Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) for approval. The Children's Health Insurance Program Reauthorization Act of 2009 required GAO to examine the extent to which states' rates are actuarially sound. GAO assessed CMS oversight of states' compliance with the actuarial soundness requirements and efforts to ensure the quality of data used to set rates. GAO reviewed documents, including rate-setting review files, from 6 of CMS's 10 regional offices. The selected offices oversaw 26 of the 34 states with comprehensive managed care programs; the states' programs varied in size and accounted for over 85 percent of managed care enrollment. GAO interviewed CMS officials and Medicaid officials from 11 states that were chosen based in part on variation in program size and geography. GAO recommends that CMS implement a mechanism to track state compliance with the requirements, clarify guidance on rate-setting reviews, and make use of information on data quality in overseeing states' rate setting.
Author :United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations Publisher : ISBN 13 : Total Pages :152 pages Book Rating :4.3/5 (91 download)
Book Synopsis Medicaid Managed Care by : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations
Download or read book Medicaid Managed Care written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations and published by . This book was released on 1993 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and the Environment Publisher : ISBN 13 : Total Pages :164 pages Book Rating :4.0/5 (18 download)
Book Synopsis Issues in Medicaid Managed Care by : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and the Environment
Download or read book Issues in Medicaid Managed Care written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and the Environment and published by . This book was released on 1992 with total page 164 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Managed Care in Medicaid by : Robert E. Hurley
Download or read book Managed Care in Medicaid written by Robert E. Hurley and published by . This book was released on 1993 with total page 236 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicaid Program Integrity, CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States by : U.s. Government Accountability Office
Download or read book Medicaid Program Integrity, CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-12 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: " Medicaid remains a high-risk program, partly due to concerns about improper payments. CMS oversees and supports states, in part, by reviewing their program integrity activities, hiring contractors to audit providers, and providing training. In recent years, CMS made changes to its Medicaid program integrity efforts, including a shift to collaborative audits. GAO was asked to examine CMS's oversight and support of states' Medicaid program integrity efforts. GAO examined, among other issues, (1) how CMS tailors its reviews to states' circumstances; (2) states' experiences with collaborative audits; and (3) CMS's steps to share promising program integrity practices. GAO reviewed CMS documents, including state program integrity reports, and data on collaborative audits. GAO interviewed officials from CMS and eight states selected based on expenditures, managed care use, and number of collaborative audits, among other factors. "
Book Synopsis Managed Care Programs by : Momoka Ito
Download or read book Managed Care Programs written by Momoka Ito and published by . This book was released on 2008 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: A physician usually manages a healthcare organisation and is responsible for a patient's primary needs especially medical care such as physical therapy or surgery. This book provides information concerning patients' well-beings as well as the effects of health care costs and how they reflect on the quality of care of healthcare facilities.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309493439 Total Pages :195 pages Book Rating :4.3/5 (94 download)
Book Synopsis Integrating Social Care into the Delivery of Health Care by : National Academies of Sciences, Engineering, and Medicine
Download or read book Integrating Social Care into the Delivery of Health Care written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2020-01-30 with total page 195 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond. The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend â€" at least in part â€" on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients' social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.
Book Synopsis Medicaid Financial Management by : U S Government Accountability Office (G
Download or read book Medicaid Financial Management written by U S Government Accountability Office (G and published by BiblioGov. This book was released on 2013-07 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Medicaid program spent more than $200 billion in fiscal year 2000 to meet the health care needs of nearly 34 million poor, elderly, blind, and disabled persons. States are responsible for making proper payments to Medicaid providers, recovering misspent funds, and accurately reporting costs for federal reimbursement. At the federal level, the Centers for Medicare and Medicaid Services (CMS) oversee state financial activities and ensure the propriety of expenditures reported for federal reimbursement. GAO found that weak financial oversight by CMS leaves the program vulnerable to improper payments. The Comptroller General's Standards for Internal Control in the Federal Government requires that agency managers perform risk assessment, take steps to mitigate identified risks, and monitor the effectiveness of those actions. The standards also require that authority and responsibility for internal controls be clearly defined. CMS oversight had weaknesses in each of these areas. As a result, CMS did not know if its control efforts were focused on areas of greatest risk. CMS also was not effectively implementing the controls it had in place. Furthermore, managers had not established performance standards for financial oversight activities, particularly their expenditure review activity. Limited data were collected to assess regional financial analyst performance in overseeing state internal controls and expenditures. In addition, the CMS audit resolution procedures did not collect enough information on the status of audit findings or ensure that audit findings were resolved promptly. CMS' current organizational structure lacks clear lines of authority and responsibility between the regions and headquarters.
Book Synopsis Health Care Fraud and Abuse by : Aspen Health Law Center
Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.
Book Synopsis Fraud, Abuse and Overpayments in the Medicare and Medicaid Programs by : Bentley Orr
Download or read book Fraud, Abuse and Overpayments in the Medicare and Medicaid Programs written by Bentley Orr and published by Nova Snova. This book was released on 2020-03-03 with total page 269 pages. Available in PDF, EPUB and Kindle. Book excerpt: Chapter 1 focuses on how the Centers for Medicare and Medicaid Services (CMS) identifies and combats waste, fraud, and abuse in both traditional Medicare and the Medicare Advantage program. Reducing improper payments is critical for protecting the integrity of the program and ensuring that taxpayer dollars are well spent. The Medicaid program, which provides vital health care to over 70 million Americans, regardless of preexisting conditions. GAO and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published reports on continued weaknesses and program integrity risks and Medicaid managed care. Clearly, there is a need for greater transparency on how managed care organizations spend Federal dollars and greater program integrity and oversight in Medicaid in general. Chapter 2 talks about the rate of improper payments in the Medicaid program.
Author :United States. Medicaid Bureau. Division of Analysis and Evaluation Publisher : ISBN 13 : Total Pages :36 pages Book Rating :4.:/5 (3 download)
Book Synopsis Medicaid Data by : United States. Medicaid Bureau. Division of Analysis and Evaluation
Download or read book Medicaid Data written by United States. Medicaid Bureau. Division of Analysis and Evaluation and published by . This book was released on 1977 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt:
