GAO Updates

Recent Postings from GAO

December 8, 2016

State and Local Governments' Fiscal Outlook: 2016 Update.

Fiscal sustainability presents a national challenge shared by all levels of government. GAO’s simulations of long-term fiscal trends in the state and local government sector—published since 2007—have consistently shown that state and local governments face long-term fiscal pressures driven largely by the rising health-related costs of Medicaid and the costs of health care compensation for employees and retirees.

See Report

November 18, 2016

Nursing Homes: Consumers Could Benefit from Improvements to the Nursing Home Compare Website and Five-Star Quality Rating System.

Nursing Home Compare is an online tool that allows people to research and compare nursing homes using a rating system. We found that most people think the site is helpful, but it's not perfect. For example, it lacks some key information, such as consumer satisfaction scores.

See Report

November 17, 2016

Drug Compounding: FDA Has Taken Steps to Implement Compounding Law, but Some States and Stakeholders Reported Challenges.

We found that FDA and some states collect data on the number of drug compounders, but not the volume of compounded drugs. Notably, nearly all of the states we surveyed reported having drug compounding laws or policies for pharmacists, but not for physicians. Additionally, some states reported challenges with their communication with FDA.

See Report

November 15, 2016

Medicare: Initial Results of Revised Process to Screen Providers and Suppliers, and Need for Objectives and Performance Measures.

Screening doctors and other providers to make sure they are legitimate helps. In 2011 Medicare strengthened its screening process—for example, by visiting more doctors' offices to verify information and conducting more background checks. As a result, over 700,000 medical providers lost their Medicare billing privileges, saving an estimated $2.4 billion.

See Report

Highlights of a Forum: Preventing Illicit Drug Use.

Preventing the use of illicit drugs (which includes the misuse of prescription drugs) is less expensive than treating addiction. We convened a diverse panel of education, health care, and law enforcement experts on June 22, 2016, to discuss strategies to prevent this drug use.

See Report

November 10, 2016

New GAO Transition App Allows Users to See Changes Needed Across Federal Government

To help make the upcoming presidential and congressional transitions as informed as possible, the U.S. Government Accountability Office (GAO) has launched a new mobile app that provides users easy access to the watchdog agency’s priority recommendations for improving government operations.

The app is available free of charge in the App Store® or Google Play™.

October 27, 2016

Opioid Addiction: Laws, Regulations, and Other Factors Can Affect Medication-Assisted Treatment Access

Overdoses of opioids such as heroin caused more than 28,000 deaths in the U.S. in 2014. Medication-assisted treatment (which combines medication with behavioral therapy) can reduce opioid addiction. We looked at factors that can affect patients' access to medication-assisted treatment.

See Report

October 13, 2016

Health Care Quality: HHS Should Set Priorities and Comprehensively Plan Its Efforts to Better Align Health Quality Measures.

While the Department of Health and Human Services is working to better align its health care quality measures across programs and private payers, OIG recommends that it set key priorities for these efforts and develop more meaningful measures.

See Report

October 6, 2016

Skilled Nursing Facilities: CMS Should Improve Accessibility and Reliability of Expenditure Data

GAO found that, for each fiscal year from 2011 through 2014, direct and indirect care costs were lower as a percentage of revenue, on average, at for-profit SNFs compared with nonprofit and government SNFs. Direct and indirect care costs were similarly lower at chain SNFs compared with independent SNFs. In addition, the median margin, which measures revenue relative to costs, was higher for for-profit and chain SNFs than for other SNFs in each of the 4 years.

See Report

September 29, 2016

Medicaid Fee-For-Service: State Resources Vary for Helping Beneficiaries Find Providers

Millions of Medicaid beneficiaries are in fee-for-service arrangements, in which states pay health care providers per service—if those providers participate in Medicaid. We looked at the resources available to help beneficiaries find participating health care providers.

See Report Here

September 26, 2016

Electronic Health Information: HHS Needs to Strengthen Security and Privacy Guidance and Oversight.

HHS has established an oversight program for compliance with privacy and security regulations, but actions did not always fully verify that the regulations were implemented. Specifically, HHS's Office of Civil Rights investigates complaints of security or privacy violations, almost 18,000 of which were received in 2014.

See Report Here

September 20, 2016

Highlights of a Forum: Data and Analytics Innovation: Emerging Opportunities and Challenges.

The overall goal of the forum's discussions and of this report is to help lay the groundwork for future efforts to maximize DAI benefits and minimize potential drawbacks. As such, the forum was not directed toward identifying a specific set of policies relevant to DAI. However, participants suggested that efforts to help realize the promise of DAI opportunities would be directed toward improving data access, assessing the validity of new data and models, creating a welcoming DAI ecosystem, and more generally, raising awareness of DAI’s potential among both policymakers and the general public.

See Report Here

September 15, 2016

Long-Term Care Workforce: Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers.

Federal data show that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 percent of the nation's health workforce. Federal data show that wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015. However it is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. The number of these workers, often referred to as independent providers, is believed to be significant and growing.

See Report Here

September 14, 2016

Health Care: Results of Recent Undercover Testing for Patient Protection and Affordable Care Act Coverage, and Review of Market Concentration in the Private Insurance Markets.

GAO's review of concentration in the private health-insurance market found that enrollment was concentrated among a small number of health insurance companies (issuers) in most states in 2014, including in the newly established exchanges. On average, in each state and the District of Columbia, 11 or more issuers participated in each of three types of markets—individual, small-group, and large-group—from 2011 through 2014.

See Report Here

September 12, 2016

Patient Protection and Affordable Care Act: Results of Undercover Enrollment Testing for the Federal Marketplace and a Selected State Marketplace for the 2016 Coverage Year.

As previously reported for the 2014 and 2015 coverage years, GAO's undercover testing for the 2016 coverage year found that the health-care marketplaces' eligibility determination and enrollment processes remain vulnerable to fraud. The marketplaces initially approved coverage and subsidies for GAO's 15 fictitious applications. However, three applicants were unable to put their policies in force because their initial payments were not successfully processed. GAO focused its testing on the remaining 12 applications.

See Report Here

September 12, 2016

Patient Protection and Affordable Care Act: Most Enrollees Reported Satisfaction with Their Health Plans, Although Some Concerns Exist.

To varying degrees, QHP enrollees expressed satisfaction with specific aspects of their plan, including their coverage and choice of providers, and plan affordability. Stakeholders—including experts, state departments of insurance, and others GAO interviewed—and literature GAO reviewed also revealed some concerns about QHP enrollee experiences.

See Report Here

September 12, 2016

Generic Drugs Under Medicare: Part D Generic Drug Prices Declined Overall, but Some Had Extraordinary Price Increases.

Manufacturers reported that competition, determined by the price and availability of the same drug from other manufacturers, is the primary driver of generic drug prices, as less competition could drive prices higher. Stakeholders noted that the level of competition in the generic drug market is influenced by a variety of factors, including raw material shortages, production difficulties, consolidation among manufacturers, and a backlog of new generic drug applications awaiting federal review.

See Report Here

September 9, 2016

Patient Protection and Affordable Care Act: Final Results of Undercover Testing of the Federal Marketplace and Selected State Marketplaces for Coverage Year 2015.

GAO's undercover testing for the 2015 coverage year found that the health-care marketplace eligibility determination and enrollment process for qualified health plans—that is, coverage obtained from private insurers—remains vulnerable to fraud.

See Report Here

September 9, 2016

Medicaid: Key Policy and Data Considerations for Designing a Per Capita Cap on Federal Funding.

Medicaid has been the focus of proposals to limit the federal expenditure commitment. One such approach, referred to as a per capita cap, would limit the amount of federal Medicaid funding states could receive per enrollee, adjusting the federal expenditure commitment based on the population covered. Whether to change the financing of the Medicaid program is a decision requiring congressional action. GAO was asked to examine considerations for designing a method to reimburse states on a per capita basis for individuals enrolled in Medicaid.

See Report

September 6, 2016

Private Health Insurance: In Most States and New Exchanges, Enrollees Continued to be Concentrated among Few Issuers in 2014.

In nearly all states, the number of issuers participating in individual markets decreased from 2013 to 2014, while fewer states' small group and large group markets had decreased participation. However, across the three markets, those issuers exiting each state market before 2014 generally had less than 1 percent of the market in the prior year. There were also issuers that newly entered state markets in 2014.

See report

August 1, 2016

Physician-administered Drugs: Comparison of Payer Payment Methodologies

GAO was asked to compare Medicare’s payments for Part B drugs with those of other payers. In this report GAO provides information on the payment methodologies, drug utilization management strategies, and cost-containment approaches for physician-administered drugs that are used by Medicare, Medicaid, VA, and private payers.

See Report

July 27, 2016, 2016

Medicare Part B: Data on Coupon Discounts Needed to Evaluate Methodology for Setting Drug Payment Rates

Use of drug coupons in the private sector has increased in recent years. GAO was asked to study coupon programs for drugs covered by Medicare Part B, including any implications for Part B spending.

See Report here

July 7, 2016

Drug Shortages: Certain Factors Are Strongly Associated with This Persistent Public Health Challenge. GAO-16-595, July 7

Drug shortages are a serious public health concern. GAO previously found that many shortages were of sterile injectable drugs and could generally be traced to supply disruptions caused by manufacturers slowing or halting production to address quality issues.

See Report Here

July 7, 2016

Patient Protection and Affordable Care Act: Information on Approval Process for State Innovation Waivers.

PPACA established section 1332 waivers to allow for state innovation in providing health insurance under PPACA. Under section 1332, states may seek federal approval to waive certain PPACA requirements, including requirements related to health insurance exchanges. HHS and Treasury share responsibility for reviewing and approving 1332 waivers. To receive approval, states are required to meet statutory criteria that the waiver provides coverage to at least a comparable number of state residents as would have received coverage without the waiver, that the coverage is at least as comprehensive and affordable as it would be in the absence of the waiver, and that the waiver will not increase the federal deficit. GAO was asked to examine the status of the Departments’ implementation of the review and approval process for section 1332 waivers.

See Report Here

July 1, 2016

Medicare Part B: CMS Should Take Additional Steps to Verify Accuracy of Data Used to Set Payment Rates for Drugs

Medicare Part B covers drugs typically administered by a physician. Medicare pays physicians and other providers for these drugs at an amount generally equal to the ASP of the drug plus a fixed percentage. These payment rates are calculated quarterly by CMS based on price and volume data reported by drug manufacturers. Members of Congress and others have questioned the amount that both Medicare and its beneficiaries spend on Part B drugs.

See Report Here

LTC Pharmacy News

Copyright © 2015 · All Rights Reserved · LTC Pharmacy News