GAO Releases Report on Managed Care Appeals and Grievances

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On Thursday, March 14th, the Government Accountability Office (GAO) released a report looking at Medicaid managed care appeals and grievances. In Medicaid managed care, plans must allow program participants to appeal adverse actions, such as a denial of service authorizations. In 2021, the Centers for Medicare & Medicaid Services (CMS) issued guidance that required states […]

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GAO Urges CMS to Update Hospice Rules for Reporting Abuse, Neglect

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Hospices should be required to report every example of neglect or abuse, even if the offender is not an employee, according to recommendations in a new reort from the Government Accountability Office (GAO). Currently, the Centers for Medicare & Medicaid Services (CMS) requires hospices to report abuse and/or neglect of patients involving members of the […]

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Ask the Experts: Summary of the GAO Report: Observations on the Effects of the Home Care Rule

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Through a partnership with Littler Mendelson P.C Labor & Employment Law Solutions, we are excited to share the “Ask the Experts” Article. Each week, we will feature a new question, from you our members, related to workplace issues and topics that will be answered from our experts and partners at Littler. This week, our experts at […]

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GAO Report: Home Care Rule Led to Difficulty Accessing Care, Not Higher Pay

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The Home Care Rule, created by the Department of Labor in 2015 to extend wage and overtime provisions to home care workers, resulted in patient difficulty accessing care, the end of some services, and limits on working hours for home care aides, but did not result in higher pay for those workers, according to a […]

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GAO Report Examines Hospice Disposal of Controlled Substances

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A new Government Accountability Office (GAO) report on disposal of controlled substances found substantial challenges for hospices, but also some key best practices that point the way toward new industry standards. According to the GAO report, challenges include the costs of certain disposal methods, a lack of a witness to the disposal process, and inconsistencies […]

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GAO Report Recommends CMS Receive More Authority to Enforce Safety Requirements on Hospice

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GAO report compares non-profit and for-profit hospices In recent months several reports examining aspects of the Medicare hospice benefit have been issued by oversight bodies including the Health and Human Services’ Office of the Inspector General (OIG) (previous coverage available HERE and HERE).  Most recently (November 14, 2019), the Government Accountability Office (GAO) released a […]

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CMS Chief: Prior Authorization Needed to Fight “Fraud and Abuse”

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CMS Administrator Seema Verma complained that the federal government needs more legal authority to conduct Medicare prior authorization reviews she says work well in the private sector during a speech to the America’s Health Insurance Plans 2018 National Conference on Medicare on Tuesday, October 16. Interestingly, according to a report from Inside Health Policy, Barbara […]

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GAO: State Medicaid Home-and-Community-Based Services Face Funding and Workforce Challenges

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States struggle to provide home-and-community-based services through their Medicaid programs due to workforce issues related to low pay, the complex needs of many patients, and limited funds from state governments, according to a new report from the Government Accountability Office (GAO). All state Medicaid programs provide some financial support for long-term services and supports (LTSS) […]

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Report: Improvements Needed to Prevent Medicaid Managed Care Payment Risks

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The Centers for Medicare & Medicaid (CMS) should require states to report and document the amount of overpayments by managed care organizations to providers in order to eliminate improper payments, according to a new study from the Government Accountability Office (GAO). Under this Medicaid model, states pay a set periodic amount to MCOs for each beneficiary and […]

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GAO Calls for CMS to Resume Prior Authorization Experiment

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A new report from the Government Accountability Office (GAO) calls on the Centers for Medicare & Medicaid Services (CMS) to resume or extend prior authorization experiments that have either been halted or are due to end soon. CMS began using prior authorization programs in September 2012 to ensure Medicare coverage and payment rules were met […]

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