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Medicaid Managed Care Cms Should Improve Oversight Of Access And Quality In States Long Term Services And Supports Programs
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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:
Author :United States Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781982014049 Total Pages :44 pages Book Rating :4.0/5 (14 download)
Book Synopsis Managed Care by : United States Government Accountability Office
Download or read book Managed Care written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-12-25 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: MANAGED CARE: CMS Should Improve Oversight of Access and Quality in States' Long-Term Services and Supports Programs
Author :United States. Government Accountability Office Publisher :Createspace Independent Publishing Platform ISBN 13 :9781977508195 Total Pages :42 pages Book Rating :4.5/5 (81 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 2017-09-22 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: The provision of long-term services and supports in Medicaid is a significant challenge, because of the vulnerability and service needs of beneficiaries, as well as the high cost of care. An increasing number of states have MLTSS programs, which can be used to expand community-based care and lower costs. However, whether these programs are an effective strategy depends, in part, on the design of the payment structures. GAO was asked to review states' MLTSS payment structures and CMS's oversight. This report examines (1) how selected states structured their financial incentives, and (2) CMS policies and procedures for overseeing states' payment structures. GAO reviewed relevant federal regulations, guidance, and internal control standards. For six states selected for variation in location and experience (AZ, DE, FL, KS, MN, and TX), GAO reviewed the contracts and rate certifications most recently approved by CMS, the terms and conditions set by CMS for the programs, and other payment documentation. GAO also interviewed CMS officials and Medicaid officials from the selected states.
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.F/5 ( 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 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:
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 Long-Term Care by : Kathryn G. Allen
Download or read book Long-Term Care written by Kathryn G. Allen and published by DIANE Publishing. This book was released on 2003-10 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt: Home & community-based settings have become a growing part of states' Medicaid long-term care programs, serving as an alternative to care in institutional settings, such as nursing homes. To cover such services, however, states often obtain waivers from certain federal statutory requirements. This report reviews: (1) trends in states' use of Medicaid home & community-based service (HCBS) waivers, particularly for the elderly; (2) state quality assurance approaches, including available data on the quality of care provided to elderly individuals through waivers; & (3) the adequacy of federal oversight of state waivers. Charts & tables.
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.
Book Synopsis Remaking Medicaid by : Stephen Davidson
Download or read book Remaking Medicaid written by Stephen Davidson and published by Jossey-Bass. This book was released on 1998-06-26 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written for health care executives, physicians, nurses, policymakers, health services researchers, and scholars, Remaking Medicaid offers a vision of the future to which conscientious policymakers and provider organizations, working together, can aspire.
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 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 :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.
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:
Author :United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health Publisher : ISBN 13 : Total Pages :64 pages Book Rating :4.F/5 ( download)
Book Synopsis Consumer Directed Services by : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health
Download or read book Consumer Directed Services written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and published by . This book was released on 2003 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Keeping Watch written by and published by . This book was released on 2012 with total page 53 pages. Available in PDF, EPUB and Kindle. Book excerpt: A growing number of state Medicaid agencies are planning to launch or expand programs that offer risk-based contracts to managed care organizations (MCOs) to provide long-term services and supports (LTSS) -- and, in some cases, acute and primary care -- to older adults and people with disabilities. Because these individuals often have one or more chronic health conditions, they tend to use more health services than younger people and people without disabilities. In addition, they often depend on other services and supports such as personal care to perform activities of daily living, such as bathing and eating. This study was conducted to determine the specific capacities that state Medicaid agencies need to monitor the performance of managed LTSS (MLTSS) programs. It sought to identify promising practices in state oversight as well as the monitoring capacities that should be in place when states begin to implement new or expanded MLTSS programs. Lessons were drawn from oversight practices in eight states that have many years of experience operating and overseeing MLTSS: Arizona, Massachusetts, Minnesota, New Mexico, New York, Tennessee, Texas, and Wisconsin.
