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Medicaid Managed Care Improved Oversight Needed Of Payment Rates For Long Term Services And Supports
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Author :United States Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781981884711 Total Pages :42 pages Book Rating :4.8/5 (847 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 2017-12-21 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: MEDICAID MANAGED CARE: Improved Oversight Needed of Payment Rates for Long-Term Services and Supports
Book Synopsis Medicaid Managed Care, Improved Oversight Needed of Payment Rates for Long-term Services and Supports by : United States. Government Accountability Office
Download or read book Medicaid Managed Care, Improved Oversight Needed of Payment Rates for Long-term Services and Supports written by United States. Government Accountability Office and published by . This book was released on 2017 with total page 37 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicaid Managed Care by : United States. General Accounting Office
Download or read book Medicaid Managed Care written by United States. General Accounting Office and published by . This book was released on 1995 with total page 44 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.
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 Medicaid by : United States. General Accounting Office
Download or read book Medicaid written by United States. General Accounting Office and published by . This book was released on 1993 with total page 104 pages. Available in PDF, EPUB and Kindle. Book excerpt:
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:
Book Synopsis Medicaid Eligibility Quality Control by : United States. Social and Rehabilitation Service
Download or read book Medicaid Eligibility Quality Control written by United States. Social and Rehabilitation Service and published by . This book was released on 1975 with total page 460 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.
Book Synopsis Medicaid Managed Care by : U.s. Government Accountability Office
Download or read book Medicaid Managed Care written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-08-11 with total page 40 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 Childrens 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 CMSs 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.
Book Synopsis Medicaid Hospital Payment by : Jennifer Baldwin
Download or read book Medicaid Hospital Payment written by Jennifer Baldwin and published by . This book was released on 1991 with total page 110 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Medicaid Managed Care by : Carolyn L. Yocom
Download or read book Medicaid Managed Care written by Carolyn L. Yocom and published by . This book was released on 2011-01 with total page 39 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is a print on demand edition of a hard to find publication. 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 Centers for Medicare and Medicaid Services (CMS) for approval. An Act was passed in 2009 that required an examination of the extent to which states' rates are actuarially sound. This report assessed CMS oversight of states' compliance with the actuarial soundness requirements and efforts to ensure the quality of data used to set rates. It reviewed 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' accounted for over 85 percent of managed care enrollment. Illus.
Author :Organisation for Economic Co-operation and Development Publisher :World Health Organization ISBN 13 :9240033777 Total Pages :374 pages Book Rating :4.2/5 (4 download)
Book Synopsis Pricing long-term care for older persons by : Organisation for Economic Co-operation and Development
Download or read book Pricing long-term care for older persons written by Organisation for Economic Co-operation and Development and published by World Health Organization. This book was released on 2021-08-26 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of the book is to meet the WHO GPW output of 1.2.1 - Countries enabled to develop and implement equitable health financing strategies and reforms to sustain progress towards universal health coverage. It falls under the WKC research plan for sustainable financing under population ageing. The country studies and policy briefs will be continued in 2022-23, under the technical product of “sustainable financing in the context of population ageing.” The target audience is WHO member states and their supporting academic institutions and policymakers.
Book Synopsis Improving the Quality of Long-Term Care by : Institute of Medicine
Download or read book Improving the Quality of Long-Term Care written by Institute of Medicine and published by National Academies Press. This book was released on 2001-02-27 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.
Book Synopsis Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement by : United States Government Accountability Office
Download or read book Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement written by United States Government Accountability Office and published by . This book was released on 2018-01-11 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicaid Managed Care: CMS's Oversight of States' Rate Setting Needs Improvement
Book Synopsis Medicaid Managed Care, Trends in Federal Spending and State Oversight of Costs and Enrollment by : Government Accountability Office
Download or read book Medicaid Managed Care, Trends in Federal Spending and State Oversight of Costs and Enrollment written by Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-28 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: "analyzed federal data on Medicaid expenditures for comprehensive risk-based managed care. GAO selected eight states because they used managed care for some portion of their Medicaid population and were geographically diverse. For these states, GAO reviewed state payment data and documentation, including contracts with MCOs, and interviewed state officials. GAO also reviewed federal laws to describe MLR minimums in Medicare and the private insurance market. The Department of Health and Human Services had no comments on this report. What GAO Found Federal spending for Medicaid managed care increased significantly from fiscal year 2004 through fiscal year 2014 (from $27 billion to $107 billion), and represented 38 percent of total federal Medicaid spending in fiscal year 2014. Consistent with this national trend, managed care as a proportion of total federal Medicaid spending was higher in seven of eight selected states in fiscal year 2014 compared with fiscal year 2004. Federal Expenditures for Medicaid Managed Care as a Percentage of Federal Medicaid Expenditures, in Eight States, Fiscal Years 2004 and 2014 Total and average per beneficiary payments by states to managed care organizations (MCOs) varied considerably across the eight selected states in state fiscal year 2014. For example, total payments ranged from $1.3 billion in one state to $18.2 billion in another, and average payments per beneficiary ranged from about $2,800 to about $5,200. While not required by federal policy to do so, five of the eight selected states required MCOs to annually meet minimum medical loss ratio (MLR) percentages-standards that ensure a certain proportion of payments are for medical care and, in effect, limit the amount that can be used for administrative cost and profit. These state minimums generally ranged from 83 to 85 percent, similar to the 85 percent minimums established in the Patient Protection and Affordable Care Act (PPACA) for other sources of health coverage. All MCOs in the five states had MLRs in state fiscal year 2014 that were above the state-required minimums. GAO also found that all eight selected states focused on beneficiary factors, such as assigning a beneficiary to the same managed care plan in which a family member is enrolled, when the state selects a plan for the beneficiary in the absence of the beneficiary choosing a plan-referred to as auto assignment. States also considered plan performance, for example, on quality measures and program goals, such as achieving a certain distribution of enrollment across plans. Auto assignments of beneficiaries ranged from 23 to 61 percent of managed care enrollees across the seven selected states that tracked such data. View GAO-16-77. For more information, contact Carolyn L. Yocom at (202) 512-7114 or [email protected]. Letter"
Author :United States. Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781546579632 Total Pages :28 pages Book Rating :4.5/5 (796 download)
Book Synopsis Medicaid Personal Care Services, More Harmonized Program Requirements and Better Data are Needed by : United States. Government Accountability Office
Download or read book Medicaid Personal Care Services, More Harmonized Program Requirements and Better Data are Needed written by United States. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-05-09 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicaid, a joint federal-state health care program, provides long-term services and supports for disabled and aged individuals, increasingly in home and community settings. Federal and state Medicaid spending on home- and community-based services was about $80 billion in 2014. Personal care services are a key component of this care. States can offer personal care services through many different types of programs, and each may be subject to different federal requirements established by statute, regulations, and guidance. The provision of personal care in beneficiaries' homes can pose safety risks, and these services have a high and growing rate of improper payments, including cases where services for which the state was billed were not provided. In recent years Congress has directed HHS to improve coordination of these programs which could harmonize requirements--that is, implement a more consistent administration of policies and procedures--and enhance oversight. This statement highlights key issues regarding (1) the federal program requirements to protect beneficiaries' safety and ensure that billed services are provided, and (2) the usefulness of data collected by CMS for oversight. This testimony is based on reports GAO issued in 2016 and 2017. For these reports, GAO assessed CMS data on personal care services provided to beneficiaries and state spending. GAO also reviewed federal statutes, regulations, and guidance, and interviewed CMS officials.