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Employment-Based Health Coverage and Health Reform: Selected Legal Considerations

Description: It is estimated that nearly 170 million individuals have employer-based health coverage. As part of a comprehensive health care reform effort, there has been support (including from the Obama Administration) in enacting comprehensive health insurance reform that retains the employer-based system. This report presents selected legal considerations inherent in amending two of the primary federal laws governing employer-sponsored health care: the Employee Retirement Income Security Act (ERISA) and the Internal Revenue Code (IRC).
Date: June 12, 2009
Creator: Staman, Jennifer & Liu, Edward C.
Partner: UNT Libraries Government Documents Department

The Changing Use of Health Care Services by Unmarried Older Women, 1969 to 1975: Final Report to the NRTA-AARP Andrus Foundation

Description: Final report to the National Retired Teachers Association (NRTA)- American Association of Retired Persons (AARP) Andrus Foundation. This reports on a research study of the changing use of health care services by unmarried older women from 1969 to 1975.
Date: March 12, 1982
Creator: Martin, Cora A. & Eve, Susan Brown
Partner: UNT College of Public Affairs and Community Service

Defense Health Care: Force Health Protection and Surveillance Policy Compliance Was Mixed, but Appears Better for Recent Deployments

Description: A letter report issued by the Government Accountability Office with an abstract that begins "A lack of servicemember health and deployment data hampered investigations into the nature and causes of illnesses reported by many servicemembers following the 1990-91 Persian Gulf War. Public Law 105-85, enacted in November 1997, required the Department of Defense (DOD) to establish a system to assess the medical condition of servicemembers before and after deployments. Following its September 2003 report examining Army and Air Force compliance with DOD's force health protection and surveillance policies for Operation Enduring Freedom (OEF) and Operation Joint Guardian (OJG), GAO was asked in November 2003 to also determine (1) the extent to which the services met DOD's policies for Operation Iraqi Freedom (OIF) and, where applicable, compare results with OEF/OJG; and (2) what steps DOD has taken to establish a quality assurance program to ensure that the military services comply with force health protection and surveillance policies."
Date: November 12, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Health Information Technology: CMS Took Steps to Improve Its Beneficiary Eligibility Verification System

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Centers for Medicare and Medicaid Services (CMS) currently offers to Medicare providers and Medicare Administrative Contractors the use of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Eligibility Transaction System (HETS) in a real-time data processing environment. HETS is operational 24 hours a day, 7 days a week, except during regularly scheduled maintenance Monday mornings, from midnight until 5:00 a.m., and when CMS announces other maintenance periods during one or two weekends each month. According to program officials, 244 entities were using HETS in 2012, including about 130 providers, 104 clearinghouses that provide data exchange services to about 400,000 health care providers, and 10 Medicare contractors that help CMS process claims for services. From January through June 2012, HETS processed each month an average of 1.7 million to 2.2 million queries per day with most of the queries submitted between the hours of 8:00 a.m. and 4:00 p.m. eastern time. The users with whom we spoke confirmed that operational problems they experienced with the system in 2010 and the first few months of 2011 were resolved in spring 2011 after CMS implemented several hardware and software replacements and upgrades. System performance reports for the first 6 months of 2012 showed that the average response time per transaction was less than 3 seconds. Users described experiences with the system that were consistent with these data. They told us that they are currently satisfied with the operational status of HETS and that the system provides more complete information and reliable service than other systems that they use to verify eligibility with commercial health insurers."
Date: September 12, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

President's Emergency Plan for AIDS Relief: Shift toward Partner- Country Treatment Programs Will Require Better Information on Results

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of State's (State) Office of the U.S. Global AIDS Coordinator (OGAC) has reported on President's Emergency Plan for AIDS Relief (PEPFAR) treatment program results primarily in terms of (1) numbers of people on treatment directly supported by PEPFAR, (2) percentages of eligible people receiving treatment, and (3) percentages of people alive and on treatment 12 months after starting treatment. However, these indicators do not reflect some key PEPFAR results. First, although the number of people on treatment directly supported by PEPFAR grew from about 1.7 million to 5.1 million in fiscal years 2008 through 2012, this indicator alone does not provide complete information needed for assessing PEPFAR's contributions to partner countries' treatment programs. Second, although 10 PEPFAR country teams reported that percentages of people alive and on treatment after 12 months exceeded 80 percent, data for this indicator are not always complete and have other limitations. To improve these data, according to OGAC officials, OGAC clarified its guidance and conducted data quality assessments. However, OGAC has not yet established a common set of indicators to monitor the results of PEPFAR's efforts to improve the quality of treatment programs."
Date: April 12, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Part D: Opportunities Exist for Improving Information Sent to Enrollees and Scheduling the Annual Election Period

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In Medicare Part D, enrollees in stand-alone prescription drug plans (PDPs) are allowed to switch plans during an annual coordinated election period (AEP) set under law from November 15 to December 31, with new coverage effective January 1. The Centers for Medicare & Medicaid Services (CMS) required that plan sponsors send an Annual Notice of Change (ANOC)--using either its model or a nonmodel format--before the 2008 AEP. Among other things, GAO examined: (1) stakeholders' views of the model ANOC and CMS's efforts to assure its effectiveness, and (2) how the scheduling of the AEP affects the enrollment process for beneficiaries switching PDPs. Among the largest PDP sponsors, we selected eight to interview along with other stakeholders involved in the AEP. We also obtained and analyzed data from CMS."
Date: December 12, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Workplace Safety and Health: Safety in the Meat and Poultry Industry, While Improving, Could Be Further Strengthened

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Because meatpacking is one of the most dangerous industries in the United States, we were asked to provide the Congress with information on the characteristics of workers in the meat and poultry industry and the conditions in which they work, the types of injuries and illnesses these workers incur, how injury and illness rates have changed over the past decade, and factors that may have affected these rates. We were also asked to determine what is known about the effectiveness of the Occupational Safety and Health Administration's (OSHA) efforts to improve safety and health in the meat and poultry industries."
Date: January 12, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Advantage: CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices

Description: A letter report issued by the Government Accountability Office with an abstract that begins "GAO found that diagnostic coding differences exist between MA plans and Medicare FFS. Using data on beneficiary characteristics and regression analysis, GAO estimated that before CMS’s adjustment, 2010 MA beneficiary risk scores were at least 4.8 percent, and perhaps as much as 7.1 percent, higher than they likely would have been if the same beneficiaries had been continuously enrolled in FFS. The higher risk scores were equivalent to $3.9 billion to $5.8 billion in payments to MA plans. Both GAO and CMS found that the impact of coding differences increased over time. This trend suggests that the cumulative impact of coding differences in 2011 and 2012 could be larger than in 2010."
Date: January 12, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Physician Feedback Program: CMS Faces Challenges with Methodology and Distribution of Physician Reports

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to develop a program to give physicians confidential feedback on the resources used to provide care to Medicare beneficiaries. In response, HHS's Centers for Medicare & Medicaid Services (CMS) has established and implemented the Physician Feedback Program by distributing feedback reports to an increasing number of physicians that provided data on resources used and the quality of care. MIPPA mandated that GAO conduct a study of this program. To address this mandate, GAO identified (1) methodological challenges CMS faces in developing feedback reports and approaches CMS has tested to address them and (2) challenges CMS faces in distributing feedback reports and CMS's plans to address them. GAO interviewed CMS officials and representatives from the program contractor and reviewed relevant documentation."
Date: August 12, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Influenza Pandemic: Increased Agency Accountability Could Help Protect Federal Employees Serving the Public in the Event of a Pandemic

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Protecting federal workers essential to ensuring the continuity of the country's critical operations will involve new challenges in the event of a pandemic influenza outbreak. This requested report discusses (1) the extent to which agencies have made pandemic plans to protect workers who cannot work remotely and are not first responders, (2) the pandemic plans selected agencies have for certain occupations performing essential functions other than first response, and (3) the opportunities to improve agencies' workforce pandemic plans. GAO surveyed pandemic coordinators from 24 agencies and selected three case study occupations for review: federal correctional workers, staff disbursing Treasury checks, and air traffic controllers."
Date: June 12, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Physician Services: Concierge Care Characteristics and Considerations for Medicare

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Concierge care is an approach to medical practice in which physicians charge their patients a membership fee in return for enhanced services or amenities. The recent emergence of concierge care has prompted federal concern about how the approach might affect beneficiaries of Medicare, the federal health insurance program for the aged and some disabled individuals. Concerns include the potential that membership fees may constitute additional charges for services that Medicare already pays physicians for and that concierge care may affect Medicare beneficiaries' access to physician services. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed GAO to study concierge care and its relationship to Medicare. Using a variety of methods, including a nationwide literature search and telephone interviews, GAO identified 146 concierge physicians and surveyed concierge physicians in fall 2004. GAO analyzed responses from 112 concierge physicians. GAO also reviewed relevant laws, policies, and available data on access to physician services and interviewed officials at the Department of Health and Human Services (HHS) and representatives of Medicare beneficiary advocacy groups."
Date: August 12, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Fee-for-Service Beneficiary Access to Physician Services: Trends in Utilization of Services, 2000 to 2002

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "In the 1990s, several reforms to Medicare physician fees were implemented to help control spending growth in the traditional Medicare program, known as fee-for-service (FFS) Medicare. Concerns were raised that these reforms might have a negative impact on Medicare beneficiaries' access to physician services, but at the end of the decade, there was little or no evidence of nationwide access problems. In 2002, access concerns were again raised when Medicare physician fees were reduced 5.4 percent. Some policymakers have questioned whether access to physician services may have diminished either nationwide, in certain geographic areas, or for certain beneficiaries needing high-cost services. In October 2003, we briefed the Senate Finance Committee on trends from 2000 to 2002 in (1) Medicare beneficiaries' use of physician services, an indicator of access to these services, and (2) physicians' decisions to "accept assignment," that is, accept Medicare's fee as payment in full. This report addresses the same two objectives and expands on the information provided in our October 2003 briefing."
Date: January 12, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nonprofit Hospitals: Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Nonprofit hospitals qualify for federal tax exemption from the Internal Revenue Service (IRS) if they meet certain requirements. Since 1969, IRS has not specified that these hospitals have to provide charity care to meet these requirements, so long as they engage in activities that benefit the community. Many of these activities are intended to benefit the approximately 47 million uninsured individuals in the United States who need financial and other help to obtain medical care. Previous studies indicated that nonprofit hospitals may not be defining community benefit in a consistent and transparent manner that would enable policymakers to hold them accountable for providing benefits commensurate with their tax-exempt status. GAO was asked to examine (1) IRS's community benefit standard and the states' requirements, (2) guidelines nonprofit hospitals use to define the components of community benefit, and (3) guidelines nonprofit hospitals use to measure and report the components of community benefit. To address these objectives, GAO analyzed federal and state laws; the standards and guidance from federal agencies and industry groups; and 2006 data from California, Indiana, Massachusetts, and Texas. GAO also interviewed federal and state officials, and industry group representatives. IRS stated that the report in general was accurate, but noted several concerns regarding the description of the community benefit standard. CMS did not have any comments."
Date: September 12, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Defense Health Care: Applying Key Management Practices Should Help Achieve Efficiencies within the Military Health System

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) has identified 11 initiatives aimed at slowing its rising health care costs, but has not fully applied results-oriented management practices in developing plans to implement and monitor its initiatives. Results-oriented management practices include developing plans that identify goals, activities, and performance measures; resources and investments; organization roles, responsibilities, and coordination; and key external factors that could affect goals, such as a decrease of funding to a program. At the conclusion of GAO’s review, DOD had completed and approved a detailed implementation plan, including a cost savings estimate, for just 1 of its 11 initiatives. Developing cost savings estimates is critical to successful management of the initiatives for achieving the 2010 Quadrennial Defense Review’s call for reduced growth in medical costs. DOD also has not completed the implementation of an overall process for monitoring progress across its portfolio of health care initiatives and has not completed the process of identifying accountable officials and their roles and responsibilities for all of its initiatives. Without comprehensive, results-oriented plans, a monitoring process, and clear leadership accountability, DOD may be hindered in its ability to achieve a more cost-efficient Military Health System, address its medical readiness goals, improve its overall population health, and improve its patients’ experience of care."
Date: April 12, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicaid: Enrollment and Expenditures for Qualified Individual and Transitional Medical Assistance Programs

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "The QI program enrolled about 426,000 individuals nationwide in 2009--the most recent year for which comprehensive enrollment data were available--with expenditures of about $431 million. While QI enrollment increased 30 percent from fiscal year 2006 to fiscal year 2009, program expenditures increased at a slightly faster rate, rising 39 percent during this time. On average, one quarter of individuals potentially eligible for the QI program were enrolled during fiscal years 2006 through 2009. However, the percentage of eligible individuals enrolled in the program climbed from 21 percent in fiscal year 2006 to 29 percent in fiscal year 2009. CMS does not have comprehensive national data on TMA enrollment and expenditures; the 41 states that had enrollment data reported that over 3.5 million individuals were enrolled in TMA in 2011, the most recent year for which complete enrollment data were reported by the highest number of states. Fewer states were able to report TMA expenditure data; however, 32 states reported TMA total expenditures of about $3.9 billion in 2011."
Date: December 12, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Comprehensive Outpatient Rehabilitation Facilities: High Medicare Payments in Florida Raise Program Integrity Concerns

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Comprehensive Outpatient Rehabilitation Facilities (CORF) are highly concentrated in Florida. These facilities, which provide physical therapy, occupational therapy, speech-language pathology services, and other related services, have been promoted as lucrative business opportunities for investors. Aware of such promotions, the Chairman, Senate Committee on Finance, raised concerns about whether Medicare could be vulnerable to overbilling for CORF services. In this report, focusing our review on Florida, we (1) compared Medicare's outpatient therapy payments to CORFs in 2002 with its payments that year to other facility-based outpatient therapy providers and (2) assessed the program's effectiveness in ensuring that payments to CORFs complied with Medicare rules."
Date: August 12, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Defense Health Care: DOD Needs to Address the Expected Benefits, Costs, and Risks for Its Newly Approved Medical Command Structure

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) operates one of the largest and most complex health systems in the nation and has a dual health care mission--readiness and benefits. The readiness mission provides medical services and support to the armed forces during military operations. The benefits mission provides health care to over 9 million eligible beneficiaries, including active duty personnel, retirees, and dependents worldwide. Past Government Accountability Office (GAO) and other reports have recommended changes to the military health system (MHS) structure. GAO was asked to (1) describe the options for structuring a unified medical command recommended in recent studies by DOD and other organizations and (2) assess the extent to which DOD has identified the potential impact these options would have on the current MHS. GAO analyzed studies and reports prepared by DOD's Joint/Unified Medical Command Working Group, the Defense Business Board, and the Center for Naval Analyses, and interviewed department officials."
Date: October 12, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA and DOD Health Care: Efforts to Coordinate a Single Physical Exam Process for Servicemembers Leaving the Military

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Servicemembers who leave the military and file disability claims with the Department of Veterans Affairs (VA) may be subject to potentially duplicative physical exams in order to meet requirements of both the Department of Defense's (DOD) military services and VA. To streamline the process for these servicemembers, the military services and VA have attempted to coordinate their physical exam requirements by developing a single separation exam program. In 1998, VA and DOD signed a memorandum of understanding (MOU) instructing local units to establish single separation exam programs. This report examines (1) VA's and the military services' efforts to establish single separation exam programs, and (2) the challenges to establishing single separation exam programs. To obtain this information, GAO interviewed VA and military service officials about establishing the program; evaluated existing programs at selected military installations; and visited selected installations that did not have programs."
Date: November 12, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Nursing Home Deaths: Arkansas Coroner Referrals Confirm Weaknesses in State and Federal Oversight of Quality of Care

Description: A letter report issued by the Government Accountability Office with an abstract that begins "GAO was asked to assess the effectiveness of nursing home oversight by considering the effect of a unique Arkansas law that requires county coroners to investigate all nursing home deaths. Coroners refer cases of suspected neglect to the state survey agency and law enforcement entities such as the state Medicaid Fraud Control Unit (MFCU). The Centers for Medicare & Medicaid Services (CMS) contracts with survey agencies in every state to periodically inspect nursing homes and investigate allegations of poor care or neglect. MFCUs are charged with investigating and prosecuting resident neglect. GAO examined (1) the results of Arkansas coroner investigations, (2) the state survey agency's experience in investigating coroner referrals, and (3) whether weaknesses in state and federal nursing home oversight identified in prior GAO reports were evident in the survey agency's investigation of coroner referrals."
Date: November 12, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Unfunded Mandates: Analysis of Reform Act Coverage

Description: A letter report issued by the General Accounting Office with an abstract that begins "The Unfunded Mandates Reform Act of 1995 (UMRA) was enacted to address concerns about federal statutes and rules that require state, local, and tribal governments or the private sector to expend resources to achieve legislative goals. UMRA generates information about the nature and size of potential federal mandates to assist Congress and agency decision makers in their consideration of proposed legislation and rules. However, concerns about actual or perceived federal mandates continue. To provide information and analysis regarding UMRA's implementation, GAO was asked to (1) describe the applicable procedures, definitions, and exclusions under UMRA for identifying federal mandates in statutes and rules, (2) identify statutes and final rules that contained federal mandates under UMRA, and (3) provide examples of statutes and final rules that were not identified as federal mandates, but that affected parties might perceive as "unfunded mandates," and the reasons these statutes and rules were not federal mandates under UMRA. GAO focused on statutes enacted and final rules issued in 2001 and 2002 to address the second and third objectives."
Date: May 12, 2004
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare: High-Expenditure Part B Drugs

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "In 2010, the 55 highest-expenditure Part B drugs represented $16.9 billion in spending, or about 85 percent of all Medicare spending on Part B drugs, which totaled $19.5 billion. The number of Medicare beneficiaries who received each of these drugs varied from 15.2 million receiving the influenza vaccines to 660 hemophilia A patients receiving a group of biologicals known collectively as factor viii recombinant, which had the largest average annual cost per beneficiary--$217,000. Our analysis showed that most of the 55 drugs increased in expenditures, prices, and average annual cost per beneficiary from 2008 to 2010. The 5 drugs with the largest increase in Medicare expenditures over this time period also had the largest increase in the number of beneficiaries receiving each drug. Four of the 10 drugs which showed the greatest increase in expenditures were also among the 10 drugs showing the greatest price increases."
Date: October 12, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Environmental Health: EPA Has Made Substantial Progress but Could Improve Processes for Considering Children's Health

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Environmental Protection Agency (EPA) has made substantial progress in addressing more than half of the recommendations GAO made in a January 2010 report concerning the agency's efforts to protect children's health. Specifically, EPA has fully implemented five of the eight recommendations made by GAO. For example, for a recommendation that EPA ensure that its strategic plan expressly articulate children-specific goals, objectives, and targets, in September 2010, EPA issued an agency-wide strategic plan that identifies children's health as a top agency priority with goals, objectives, and targets. In addition, EPA took some steps to address the remaining three recommendations from GAO's January 2010 report but has not fully implemented them, including a recommendation that the agency strengthen the data system that identifies and tracks development of rulemakings and other actions to ensure they comply with the 1995 policy on evaluating health risks to children."
Date: August 12, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare: Appropriate Dispensing Fee Needed for Suppliers of Inhalation Therapy Drugs

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) revised the payment formula for most of the outpatient drugs, including inhalation therapy drugs, covered under Medicare part B. Under the revised formula, effective 2005, Medicare's payment is intended to be closer to acquisition costs. The Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, also pays suppliers of inhalation therapy drugs a $5 per patient per month dispensing fee. Suppliers have raised concerns that once drug payments are closer to acquisition costs, they will no longer be able to use overpayments on drugs to subsidize dispensing costs, which they state are higher than $5. As directed by MMA, GAO (1) examined suppliers' acquisition costs of inhalation therapy drugs and (2) identified costs to suppliers of dispensing inhalation therapy drugs to Medicare beneficiaries."
Date: October 12, 2004
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department