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                    Recent Reports
    Medicare and Medicaid: Additional Actions Needed to Enhance Program Integrity and Save BillionsGAO-24-107487
      
	Published:  Apr 16, 2024


	Publicly Released: Apr 16, 2024
          Prescription Drugs: Selected States' Regulation of Pharmacy Benefit ManagersGAO-24-106898
      
	Published:  Mar 18, 2024


	Publicly Released: Apr 15, 2024
          Medicaid Managed Care: Additional Federal Action Needed to Fully Leverage New Appeals and Grievances DataGAO-24-106627
      
	Published:  Mar 14, 2024


	Publicly Released: Mar 14, 2024
          Hospital Financing: Volume Limits and Reporting Could Help Manage Risks of Expanding FHA's Mortgage Insurance ProgramGAO-24-106480
      
	Published:  Jan 25, 2024


	Publicly Released: Jan 25, 2024
          Medicaid Managed Care: Rapid Spending Growth in State Directed Payments Needs Enhanced Oversight and TransparencyGAO-24-106202
      
	Published:  Dec 14, 2023


	Publicly Released: Dec 14, 2023
          Health Care Funding: Federal Funding for Certain Organizations Providing Health-Related Services, 2019 through 2022GAO-24-106215
      
	Published:  Nov 17, 2023


	Publicly Released: Dec 12, 2023
    
    

  
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Open Recommendations (114 total)
  Medicaid Managed Care: Additional Federal Action Needed to Fully Leverage New Appeals and Grievances Data
GAO-24-106627
        Mar 14, 2024

  Show
    1Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should require states to report on the outcomes of Medicaid managed care appeals (e.g., the extent to which they were decided in favor of enrollees) and number of denials. (Recommendation 1)
                                                                                                      Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Medicaid Managed Care: Additional Federal Action Needed to Fully Leverage New Appeals and Grievances Data
GAO-24-106627
        Mar 14, 2024

  Show
    1Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should implement its planned actions for analyzing the Medicaid managed care appeals and grievances data, using it for oversight, and making it publicly available. (Recommendation 2)
                                                                                                      Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Medicaid Managed Care: Rapid Spending Growth in State Directed Payments Needs Enhanced Oversight and Transparency
GAO-24-106202
        Dec 14, 2023

  Show
    1Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should require states to consider health equity priorities in designing evaluations of state directed payments. (Recommendation 3)
                                                                                                      Open
As of April 2024, GAO continues to monitor CMS progress toward implementing this recommendation.Medicaid Managed Care: Rapid Spending Growth in State Directed Payments Needs Enhanced Oversight and Transparency
GAO-24-106202
        Dec 14, 2023

  Show
    3Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should enhance the agency's fiscal guardrails for approving state directed payments by establishing a definition of, and standards for, assessing whether directed payments result in payment rates that are reasonable and appropriate, and communicating those to states; determining whether additional limits are needed; and requiring states to submit data on actual spending amounts at renewal. (Recommendation 1)
                                                                                                      Open
As of April 2024, GAO continues to monitor CMS progress toward implementing this recommendation.Centers for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should make publicly available all approval documents related to new and renewed state directed payments, including application attachments, state evaluation plans, and evaluation results. (Recommendation 4)
                                                                                                      Open
As of April, GAO continues to monitor CMS progress toward implementing this recommendation.Centers for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should consider interim evaluation results or other performance information from states at renewal to gain more timely information on whether state directed payments are advancing quality goals. (Recommendation 2)
                                                                                                      Open
As of April 2024, GAO continues to monitor CMS progress toward implementing this recommendation.Medicaid Program Integrity: Opportunities Exist for CMS to Strengthen Use of State Auditor Findings and Collaboration
GAO-23-105881
        Sep 21, 2023

  Show
    1Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should build on the agency's efforts to collaborate with state auditors on Medicaid oversight activities. These collaboration efforts should include continuing to identify potential updates to the Compliance Supplement, having regular discussions to address auditor training needs, annually sharing information on trends in audit findings and program risks, and increasing auditor awareness of actions taken to address single audit findings. (Recommendation 2)
                                                                                                      Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Medicaid Program Integrity: Opportunities Exist for CMS to Strengthen Use of State Auditor Findings and Collaboration
GAO-23-105881
        Sep 21, 2023

  Show
    1Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should annually examine state auditors' Medicaid findings to identify trends across states and use this information to inform oversight activities and audit processes. (Recommendation 1)
                                                                                                      Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Medicare Part D: CMS Should Monitor Effects of Rebates on Plan Formularies and Beneficiary Spending
GAO-23-105270
        Sep 5, 2023

  Show
    1Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS should monitor the effect of rebates on plan sponsor formulary design and on Medicare and beneficiary spending to assess whether rebate practices are likely to substantially discourage enrollment by certain beneficiaries.
                                                                                                      Open
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.Medicaid: CMS Oversight and Guidance Could Improve Recovery Audit Contractor Program
GAO-23-106025
        Jun 28, 2023

  Show
    1Open Recommendations

  Agency Affected
                                                          Recommendation
                                                          StatusCenters for Medicare & Medicaid Services
                                                                                                      The Administrator of CMS, in collaboration with the states, should describe the effectiveness of the RAC program and include recommendations, if any, for expanding or improving the program in their annual report to Congress. (Recommendation 3)
                                                                                                      Open – Partially Addressed
In its comments on our draft report, HHS stated that it partially concurred with this recommendation. Specifically, CMS stated that it concurs with the recommendation to make information available to expand or improve the Recovery Audit Contractor (RAC) program. CMS stated it plans to add certain information to the annual Medicare and Medicaid Program Integrity Report to Congress. This added information includes a breakdown of the states with full or partial exemptions, and promising state practices in RAC administration that other states may use when determining if and how to administer a RAC program. CMS further stated its current identification of RAC overpayment recoveries in the report already satisfies the statutory requirement to report on the effectiveness of states' Medicaid RAC programs. We agree that the reporting of RAC overpayment recoveries is important for determining the effectiveness of the Medicaid RAC program. However, Congress and other external stakeholders do not have other important information that would help them monitor how well the Medicaid RAC program is identifying and reducing improper payments. One such metric is a breakout of overpayments collected, underpayments restored, and amounts overturned on appeal. CMS's planned actions would help meet the intent of our recommendation, if effectively implemented. In November 2023, CMS issued its fiscal year 2022 report to Congress that included information on the number of states with CMS approved exceptions to Medicaid RAC implementation as well as information on the recovery of overpayments. Additionally, in January 2024, HHS stated that beginning with the fiscal year 2023 report to Congress, CMS is planning to include a breakdown of the states with full or partial exemptions, and promising state practices, if any. HHS stated that CMS is tentatively targeting to release the fiscal year 2023 report to Congress in fall of 2024. We will continue to monitor CMS's actions to address this recommendation.View More RecommendationsRelated Pages
    RelatedFederal Health Care Spending
          RelatedWomen and Gender in Public Policy
          RelatedElder Abuse
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