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Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act

Description: This report provides background information and three tables summarizing legislative actions taken to repeal, defund, delay, or otherwise amend the Affordable Care Act (ACA) since it was enacted. Table 1 summarizes the ACA changes that have been signed into law. Table 2 lists all the House-passed ACA bills. Table 3 summarizes the ACA provisions in the vetoed reconciliation bill.
Date: February 5, 2016
Creator: Redhead, C. S. & Kinzer, Janet
Partner: UNT Libraries Government Documents Department

Use of the Annual Appropriations Process to Block Implementation of the Affordable Care Act (FY2011-FY2016)

Description: This report summarizes the language related to the Affordable Care (ACA) that was added to annual appropriations legislation by congressional appropriators since the ACA was signed into law. The information is presented in a table. While a detailed examination of the ACA itself is beyond the scope of this report, a brief overview of the ACA's core provisions and its impact on federal spending is provided as context for the material in the table. Congress remains deeply divided over implementation of the Affordable Care Act (ACA), which President Obama signed into law in March 2010.
Date: January 5, 2016
Creator: Redhead, C. S. & Cornell, Ada S.
Partner: UNT Libraries Government Documents Department

Health Care: Constitutional Rights and Legislative Powers

Description: This report analyzes constitutional and legal issues pertaining to a right to health care, as well as the power of Congress to enact and fund health care programs. It also discusses legal issues that have been raised regarding the power of Congress to mandate that individuals purchase health insurance, and the ability of states to "nullify" or "opt out" of such a requirement.
Date: April 5, 2010
Creator: Swendiman, Kathleen S.
Partner: UNT Libraries Government Documents Department

Reported Medicaid Year 2000 Readiness

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO determined: (1) what the Health Care Financing Administration (HCFA) is doing to ensure that the year 2000 computing challenge does not adversely affect the delivery of Medicaid benefits; and (2) the readiness of states to successfully transition to year 2000 for Medicaid."
Date: October 5, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Health Care: Fraud Schemes Committed by Career Criminals and Organized Criminal Groups and Impact on Consumers and Legitimate Health Care Providers

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the proliferation of Medicare, Medicaid, and private health insurance fraud on the part of criminals and organized criminal groups, focusing on: (1) the makeup and prior activities of such groups; (2) how organized criminal groups created medical entities or used legitimate medical entities or individuals to defraud Medicare, Medicaid, and private insurers; (3) schemes used by such groups to commit health care fraud; and (4) the impact that illegal activity by such groups has on consumers and legitimate health care providers."
Date: October 5, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Prescription Drugs: Prices Available Through Discount Cards and From Other Sources

Description: Correspondence issued by the General Accounting Office with an abstract that begins "This report compares prices for prescription drugs purchased using drug discount cards with prices available at local pharmacies or over the Internet. Using a list of 17 widely prescribed drugs, GAO documents prices from (1) five companies that administer large drug discount card programs, (2) five Internet pharmacies, and (3) several retail pharmacies in four different areas."
Date: December 5, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medical Devices: Status of FDA's Program for Inspections by Accredited Organizations

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Food and Drug Administration (FDA) inspects domestic and foreign establishments where U.S.-marketed medical devices are manufactured to assess compliance with FDA's quality system requirements for ensuring good manufacturing practices and other applicable requirements. The Medical Device User Fee and Modernization Act of 2002 (MDUFMA) required FDA to accredit organizations to inspect certain establishments where devices that are marketed in both the United States and other countries are manufactured. This report includes information that MDUFMA requires GAO to provide on (1) the number of organizations that sought accreditation, the number that were accredited, and reasons for denial of accreditation and (2) the number of inspections conducted by accredited organizations. It also includes information about factors that could influence manufacturers' interest in voluntarily requesting and paying for an inspection by an accredited organization. GAO examined FDA documents, interviewed FDA officials, and obtained information from FDA on the number of inspections conducted from March 11, 2004--when FDA first cleared an accredited organization to conduct independent inspections--through October 31, 2006. GAO also interviewed affected entities, including accredited organizations and medical device manufacturers."
Date: January 5, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

School Mental Health: Role of the Substance Abuse and Mental Health Services Administration and Factors Affecting Service Provision

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "The U.S. Surgeon General reported in 1999 that about one in five children in the United States suffers from a mental health problem that could impair their ability to function at school or in the community. Yet many children receive no mental health services. While many of the existing mental health services for children are provided in schools, the extent and manner of school mental health service delivery vary across the country and within school districts. Federally led initiatives have identified schools as a potentially promising location for beginning to address the mental health needs of children. Both the report of the Surgeon General's Conference on Children's Mental Health and the 2003 report of the President's New Freedom Commission on Mental Health--Achieving the Promise: Transforming Mental Health Care in America--identified school mental health services as a means of improving children's mental and emotional well-being. At the federal level, the Department of Health and Human Services' (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) has a stated mission of building resilience and facilitating recovery for people--including children at risk for mental health problems. Although SAMHSA is the federal government's lead agency for mental health services, other federal agencies and departments, such as HHS's Centers for Disease Control and Prevention (CDC) and the Department of Education (Education), engage in, or coordinate, activities related to school mental health services in various ways. SAMHSA works to achieve its mission chiefly by providing grants and technical assistance. For example, the agency uses grant funds and technical assistance to support the expansion of mental health service capacity and the use of evidence-based practices in mental health services. Typically, efforts that have been validated by some form of documented scientific data are referred to ...
Date: October 5, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Part D Low-Income Subsidy: Assets and Income Are Both Important in Subsidy Denials, and Access to State and Manufacturer Drug Programs Is Uneven

Description: A letter report issued by the Government Accountability Office with an abstract that begins "To help defray the cost of prescription drugs for beneficiaries with limited means, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) included the low-income subsidy (LIS) in the Part D prescription drug insurance program. To qualify for the LIS, beneficiaries must be enrolled in a Part D plan and their assets and income must be less than the thresholds established by the law. Part D is administered by the Centers for Medicare & Medicaid Services (CMS), and the Social Security Administration (SSA) administers the eligibility determination for the LIS. The MMA directed GAO to compare the utilization of and access to Part D prescription drugs among beneficiaries who received the LIS with those who were denied it because of the amount of their assets. This report focuses on beneficiaries' access to prescription drugs by examining (1) the importance of assets and income in LIS denials in 2006 and 2007, and (2) state and manufacturer programs providing access to prescription drugs for Medicare beneficiaries. To do this, GAO analyzed data from SSA, reviewed information on state and drug manufacturer pharmaceutical programs, and interviewed officials from SSA, CMS, state programs, advocacy organizations, and pharmaceutical manufacturer programs."
Date: September 5, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicaid and CHIP: Reports for Monitoring Children's Health Care Services Need Improvement

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Medicaid and the Children's Health Insurance Program (CHIP)--two joint federal-state health care programs for low-income families and children--play a critical role in addressing the health care needs of children. In 2008, more than 36 million children in the United States received health care coverage through Medicaid or CHIP. Like all children, children covered by Medicaid and CHIP may have health care conditions that could warrant care from primary care or specialist providers. At the same time, a significant number of children in Medicaid and CHIP may not be receiving basic preventive care, which these programs generally cover. For example, we reported in 2009 that, on the basis of parents' reports in national surveys, about 40 percent of children in Medicaid and CHIP had not had a well-child checkup over a 2-year period. Many state Medicaid and CHIP programs and other health care purchasers have started initiatives to improve care coordination for children and provide children with access to networks of care. For the purposes of this report, care coordination is broadly defined as a process in which an individual or group helps to arrange a patient's primary and specialty health care services. Care coordination can be provided by primary care providers or through other individuals such as social workers or case managers. Care coordination activities can include communication--sharing information among participants in a patient's care--and linking patients to community resources. Care coordination can help children gain access to a network of care, that is, a set of providers who are available to help address the primary and specialty health care needs of a patient. The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), oversees state Medicaid and CHIP ...
Date: April 5, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Status of VA's Approach in Conducting the National Vietnam Veterans Longitudinal Study

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "In addition to providing health care to over 5 million veterans each year, the Veterans Health Administration, part of the Department of Veterans Affairs (VA), funds research on specific health conditions that veterans may experience. One condition that is examined in VA-funded research is post-traumatic stress disorder (PTSD), an anxiety disorder that can occur after a person is exposed to a life-threatening event. According to VA, experts estimate that up to 30 percent of Vietnam veterans and up to 20 percent of Operation Enduring Freedom veterans and Operation Iraqi Freedom veterans have experienced PTSD. Veterans suffering from PTSD may experience problems sleeping, maintaining relationships, and returning to their previous civilian lives. Additionally, studies have shown that many veterans suffering from PTSD are more likely to be diagnosed with cardiovascular disease and other diseases. After the Vietnam War, Congress wanted information about the psychological effects of the war on Vietnam veterans to inform the need for PTSD services at VA. Consequently, in 1983, Congress mandated that VA provide for the conduct of a study on PTSD and related postwar psychological problems among Vietnam veterans. VA contracted with an external entity, the Research Triangle Institute, to conduct the National Vietnam Veterans Readjustment Study (NVVRS). This cross-sectional study determined the incidence and prevalence of PTSD among Vietnam veterans and Vietnam-era veterans. Under contact with VA, Research Triangle Institute researchers designed the study and analyzed the information collected for the study, which was initiated in 1984 and completed in 1988. Participants' identities were not provided to VA because of the Research Triangle Institute's concerns about Vietnam veterans' distrust of government agencies. According to VA, the NVVRS was a landmark study and is the only nationally representative study that focuses on PTSD in ...
Date: May 5, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

SCHIP: HHS Continues to Approve Waivers That Are Inconsistent with Program Goals

Description: Correspondence issued by the General Accounting Office with an abstract that begins "States provide health care coverage to about 60 million low-income uninsured adults and children largely through two federal-state programs--Medicaid and the State Children's Health Insurance Program (SCHIP). Medicaid, established in title XIX of the Social Security Act, generally covers low-income families and elderly and disabled individuals, and SCHIP, established in title XXI of the act, covers children in families whose incomes, although low, are above Medicaid's eligibility requirements. In 2001, the Secretary of Health and Human Services announced a new initiative--the Health Insurance Flexibility and Accountability Initiative (HIFA)--under which states could expand coverage to uninsured populations using Medicaid and SCHIP funds. HIFA encourages states to develop coordinated public and private health insurance coverage options and to target program resources to uninsured individuals with incomes below 200 percent of the federal poverty level (FPL). Authority for this initiative comes from section 1115 of the Social Security Act, which allows the Secretary to waive many of the statutory requirements of Medicaid or SCHIP in the case of experimental, pilot, or demonstration projects that promote program objectives. Within the Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) has the lead role in reviewing HIFA waiver applications. In a July 2002 report, we raised legal and policy concerns about the need to clearly establish purposes and populations for which SCHIP funds may be spent. Our specific concerns related to HHS's approval of a HIFA waiver for Arizona, which proposed using unspent SCHIP funds to cover childless adults. We reported that, in our view, approving a waiver to use SCHIP funds for expanding coverage to childless adults was inconsistent with SCHIP's statutory objective to expand health coverage to low-income children. Because the SCHIP statute requires that ...
Date: January 5, 2004
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Ryan White Care Act: Impact of Legislative Funding Proposal on Urban Areas

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act), administered by the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and their family members. In December 2006 the Ryan White HIV/AIDS Treatment Modernization Act of 2006 reauthorized CARE Act programs for fiscal years 2007 through 2009. In July 2007, the House of Representatives passed H.R. 3043, the Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriations Act for fiscal year 2008, which contains a hold-harmless provision covering funding for urban areas that receive funding under the CARE Act. This bill has not been passed by the Senate. Under the CARE Act, funding for Eligible Metropolitan Areas (EMA) and Transitional Grant Areas (TGA) is primarily provided through three categories of grants: (1) formula grants that are awarded based on the case counts of people with HIV/AIDS living in an urban area; (2) supplemental grants that are awarded on a competitive basis based on an urban area's demonstration of need, including criteria such as HIV/AIDS prevalence; and (3) Minority AIDS Initiative (MAI) grants, which are supplemental grants awarded on a competitive basis for urban areas to address disparities in access, treatment, care, and health outcomes. The CARE Act includes a hold-harmless provision that limited the decrease that an EMA could receive in its formula funding for fiscal year 2007 to 5 percent of the fiscal year 2006 formula funding it would have received if the revised urban area allocations required by the Modernization Act of 2006 had been in place in fiscal year 2006. For fiscal years 2008 ...
Date: October 5, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Privacy: Domestic and Offshore Outsourcing of Personal Information in Medicare, Medicaid, and TRICARE

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Federal contractors and state Medicaid agencies are responsible for the day-to-day operations of the Medicare, Medicaid, and TRICARE programs. Because these entities may contract with vendors to perform services involving the use of personal health data, outsourcing and privacy protections are of interest. GAO surveyed all federal Medicare and TRICARE contractors and all state Medicaid agencies (a combined total of 378 entities) to examine whether they (1) outsource services--domestically or offshore--and (2) must notify federal agencies when privacy breaches occur. Survey response rates ranged from 69 percent for Medicare Advantage contractors to 80 percent for Medicaid agencies. GAO interviewed officials at the Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS), which oversees Medicare and Medicaid, and the Department of Defense's TRICARE Management Activity (TMA), which oversees TRICARE."
Date: September 5, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicaid and CHIP: Considerations for Express Lane Eligibility

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Four key considerations related to ELE's availability beyond 2013 include (1) the potential for administrative savings; (2) effects on enrollment of eligible, but not enrolled, children; (3) states' level of interest in using ELE particularly for implementing PPACA; and (4) uncertainty regarding the potential for erroneous excess payments for children enrolled through ELE."
Date: December 5, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare and Medicaid: Consumer Protection Requirements Affecting Dual-Eligible Beneficiaries Vary across Programs, Payment Systems, and States

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Medicare and Medicaid consumer protection requirements vary across programs, payment systems--either fee-for-service (FFS) or managed care--and states. Within Medicare, enrollment in managed care through the Medicare Advantage (MA) program must always be voluntary, whereas state Medicaid programs can require enrollment in managed care in certain situations. For example, Arizona requires nearly all beneficiaries, including dual-eligible beneficiaries, to enroll in managed care, but in North Carolina all beneficiaries are in FFS. In addition, Medicare and state Medicaid programs require managed care plans to meet certain provider network requirements to ensure beneficiaries have adequate access to covered services. For example, MA plans in rural counties must have at least one primary care provider per 1,000 beneficiaries. Subject to federal parameters, states establish network requirements for their Medicaid programs. For example, in California every plan must have at least one primary care provider per 2,000 beneficiaries. Finally, Medicare and Medicaid also have different appeals processes that do not align with each other. The Medicare appeals process has up to five levels of review for decisions to deny, reduce, or terminate services, with certain differences between FFS and MA. In Medicaid, states can structure appeals processes within federal parameters. States must establish a Medicaid appeals process that provides access to a state fair hearing and Medicaid managed care plans must provide beneficiaries with the right to appeal to the plan, though states can determine the sequence of these appeals. For example, Arizona requires beneficiaries to appeal to the managed care plan first, while a beneficiary in Minnesota may go directly to a state fair hearing without an initial appeal to the managed care plan."
Date: December 5, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Indian Health Service: Most American Indians and Alaska Natives Potentially Eligible for Expanded Health Coverage, but Action Needed to Increase Enrollment

Description: A letter report issued by the Government Accountability Office with an abstract that begins "GAO estimates, on the basis of recent U.S. Census Bureau data, that most American Indians and Alaska Natives will be potentially eligible for either expanded or new coverage options created by the Patient Protection and Affordable Care Act (PPACA). These options include expanded eligibility for Medicaid--the federal-state program for certain low-income individuals--and eligibility for the Health Insurance Exchanges (Exchanges), which are marketplaces where health insurance plans can be compared and purchased. While it is still unclear which states will opt to expand Medicaid, their decisions may affect a large proportion of American Indians and Alaska Natives, as GAO estimates that potential new enrollment could include about a quarter of this population. For example, in the Oklahoma City area--one of the Indian Health Service's (IHS) 12 federally designated service areas--tens of thousands of American Indians and Alaska Natives could be affected by the state of Oklahoma's decision not to expand its Medicaid program. For the Exchanges, GAO found that more than one-third of American Indians and Alaska Natives are potentially eligible for premium tax credits in the Exchanges--which help offset the cost of premiums for low-income individuals--and nearly one-third are below the income threshold for cost-sharing exemptions, which are limited to enrolled members of federally recognized tribes."
Date: September 5, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicaid in Schools: Improper Payments Demand Improvements in HCFA Oversight

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on states' practices regarding Medicaid reimbursement of school-based administrative activities, focusing on: (1) the extent to which school districts and states claim Medicaid reimbursement for school-based health services and administrative activities; (2) the appropriateness of methods states use to establish bundled rates for school-based health services and to assess the costs of administrative activities that their schools may claim as reimbursable; (3) states' retention of federal Medicaid reimbursement for services provided by schools and schools' practice of paying contingency fees to private firms; and (4) the adequacy of the Health Care Financing Administration's (HCFA) oversight of state practices regarding school-based claims, including safeguards employed to ensure appropriate billing for health services and administrative activities."
Date: April 5, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare: Access to Home Oxygen Largely Unchanged; Closer HCFA Monitoring Needed

Description: A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a legislative requirement, GAO provided information on Medicare beneficiaries' access to home oxygen equipment, focusing on: (1) changes in access to home oxygen for Medicare patients since the payment reduction mandated by the Balanced Budget Act (BBA) of 1997 took effect; and (2) actions taken by the Health Care Financing Administration (HCFA) to fulfill the BBA requirements and respond to GAO's November 1997 recommendations."
Date: April 5, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department