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The Use of Modified Adjusted Gross Income (MAGI) in Federal Health Programs

Description: This report explores how modified adjusted gross income (MAGI) is defined differently across health programs such as Medicare, the health insurance exchanges under the Affordable Care Act (ACA), and Medicaid. It also discusses why MAGI is used, and how it is applied, specific to each program. The report covers that MAGI is used to determine (1) penalty amounts owed if a person does not comply with the individual mandate or whether an individual is exempt from the individual mandate; (2) eligibility for and the amount of a premium credit to purchase coverage through a health insurance exchange; and (3) Medicaid income eligibility for certain populations.
Date: February 25, 2016
Creator: Baumrucker, Evelyne P.; Davis, Patricia A.; Fernandez, Bernadette; Mach, Annie L. & Pettit, Carol A.
Partner: UNT Libraries Government Documents Department

Veterans' Health Care: Observations on VA's Assessment of Hepatitis C Budgeting and Funding

Description: A statement of record issued by the General Accounting Office with an abstract that begins "The Department of Veterans Affairs (VA) requested and received $195 million for Hepatitis C screening and treatment in fiscal year 2000. VA's budget documentation showed that it had spent $100 million on Hepatitis C screening and treatment, leaving a difference of $95 million between its estimated and actual expenditures. However, GAO's review revealed that the difference was actually much larger--$145 million. VA's documentation showed that only $50 million was used for budgeted activities and $50 million was used for an activity not included in its original budget--treatment of conditions related to Hepatitis C. It appears that VA is unable to develop a budget estimate that can reliably forecast its Hepatitis C funding needs at this time. However, VA's Veterans Health Administration (VHA) appears to be taking reasonable steps to improve future budget estimates and thereby minimize the potential for large differences. Such steps include developing a Hepatitis C patient registry that could provide the critical data needed to improve budgetary estimates. However, this registry could take as long as 15 months to become operational, which suggests that it may not provide budgetary data in time to formulate the 2004 budget. In the meantime, VHA's ongoing efforts to upgrade its data collection systems should help improve budget estimates for fiscal year 2002. These efforts, however, have provided only minimal help in the development of VA's 2002 budget for Hepatitis C spending. As a result, it is not possible to conclude with certainty whether VA's fiscal year 2002 spending estimate of $171 million is appropriate."
Date: April 25, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare: Per Capita Method Can Be Used to Profile Physicians and Provide Feedback on Resource Use

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 directed the Secretary of Health and Human Services to develop a program to give physicians confidential feedback on the Medicare resources used to provide care to Medicare beneficiaries. GAO was asked to evaluate the per capita methodology for profiling physicians--a method which measures a patient's resource use over a fixed period of time and attributes that resource use to physicians--in order to assist the Centers for Medicare & Medicaid Services (CMS) with the development of a physician feedback approach. In response, this report examines (1) the extent to which physicians in selected specialties show stable practice patterns and how beneficiary utilization of services varies by physician resource use level; (2) factors to consider in developing feedback reports on physicians' performance, including per capita resource use; and (3) the extent to which feedback reports may influence physician behavior. GAO focused on four medical specialties and four metropolitan areas chosen for their geographic diversity and range in average Medicare spending per beneficiary. To identify considerations for developing a physician feedback system, GAO reviewed the literature and interviewed officials from health plans and specialty societies. Further, GAO drew upon literature and interviews to develop an illustration of how per capita measures could be included in a physician feedback report."
Date: September 25, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicaid Demonstration Waivers: Approval Process Raises Cost Concerns and Lacks Transparency

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The 10 new demonstrations GAO examined expanded states' use of federal funds and implemented new coverage strategies. Arizona and Texas established funding pools to make new supplemental payments beyond what they could have made under traditional Medicaid requirements and receive federal matching funds for the payments. All 10 demonstrations were approved to use different coverage strategies or impose new cost sharing requirements, including limiting benefits or imposing deductibles for certain populations."
Date: June 25, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Program Integrity: Contractors Reported Generating Savings, but CMS Could Improve Its Oversight

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Centers for Medicare and Medicaid Services (CMS) paid its Zone Program Integrity Contractors (ZPIC) about $108 million in 2012. ZPICs reported spending most of this funding on fraud case development, primarily for investigative staff, who in 2012 reported conducting about 3,600 beneficiary interviews, almost 780 onsite inspections, and reviews of more than 200,000 Medicare claims."
Date: October 25, 2013
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Hospital Quality Data: HHS Should Specify Steps and Time Frame for Using Information Technology to Collect and Submit Data

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Hospitals submit data in electronic form on a series of quality measures to the Centers for Medicare & Medicaid Services (CMS) and receive scores on their performance. Increasingly, the clinical information from which hospitals derive the quality data for CMS is stored in information technology (IT) systems. GAO was asked to examine (1) hospital processes to collect and submit quality data, (2) the extent to which IT facilitates hospitals' collection and submission of quality data, and (3) whether CMS has taken steps to promote the use of IT systems to facilitate the collection and submission of hospital quality data. GAO addressed these issues by conducting case studies of eight hospitals with varying levels of IT development and interviewing relevant officials at CMS and the Department of Health and Human Services (HHS)."
Date: April 25, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Mammography: Current Nationwide Capacity Is Adequate, but Access Problems May Exist in Certain Locations

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Mammography, an X-ray procedure that can detect small breast tumors, is an important tool for detecting breast cancer at an early stage and, when coupled with appropriate treatment, can reduce breast cancer deaths. In 2002, GAO reported in Mammography: Capacity Generally Exists to Deliver Services (GAO-02-532) that the capacity to provide mammography services was generally adequate, but that the number of mammography facilities had decreased by 5 percent from 1998 to 2001 and that about one-fourth of counties had no machines. GAO was asked to update its information on facility closures and mammography service capacity. The Food and Drug Administration (FDA) regulates mammography quality and maintains a database on mammography facilities and other capacity elements. GAO reviewed FDA data on facility closures and examined reasons for closures in recent years. GAO analyzed changes in the nation's capacity for and use of mammography services using FDA capacity data and National Center for Health Statistics data on service use. GAO also interviewed state and local officials about the effects of the loss or absence of mammography machines on access, including access for medically underserved women, such as those who are poor or uninsured."
Date: July 25, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Children's Health Insurance: SCHIP Enrollment and Expenditure Information

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Congress created the State Children's Health Insurance Program (SCHIP) in 1997 to reduce the number of uninsured poor children whose families incomes are too high to qualify for Medicaid. Congress appropriated $40 billion over 10 years (fiscal years 1998 through 2007) for SCHIP. Each state's SCHIP allotment is available as a federal match based on state expenditures. Although the SCHIP statute generally targets children in families with incomes up to 200 percent of the federal poverty level, 13 states' programs cover children in families above 200 percent of the federal poverty level. This report provides information on (1) enrollment and federal expenditures for SCHIP and estimates of the number of and costs to enroll eligible unenrolled children and income-eligible pregnant women and (2) factors that may influence states' future expenditures for SCHIP and the availability of funding for any program expansion."
Date: July 25, 2001
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Oversight of Clinical Investigators: Action Needed to Improve Timeliness and Enhance Scope of FDA's Debarment and Disqualification Processes for Medical Product Investigators

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Food and Drug Administration (FDA) oversees the clinical investigators who conduct research involving new drugs, biologics, and medical devices to ensure that their conduct does not compromise the safety of clinical trial participants or the integrity of clinical trial data. FDA can debar or disqualify investigators who have engaged in misconduct such as submitting fraudulent data. Debarred or disqualified investigators cannot engage in certain activities related to clinical research. GAO was asked to review FDA's debarment and disqualification processes. GAO examined the length of time debarment and disqualification processes have taken and factors for those time frames, and the statutory and regulatory limitations of debarment and disqualification. GAO reviewed laws, regulations, and FDA files through November 5, 2008, for (1) all investigators, study coordinators, and sub-investigators for whom FDA pursued debarment since receiving debarment authority in 1992; and (2) all clinical investigators for whom FDA pursued disqualification since FDA adopted its current process for initiating proceedings in 1998."
Date: September 25, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Influenza Pandemic: Agencies Report Progress in Plans to Protect Federal Workers but Oversight Could Be Improved

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In 2012, federal agencies reported they had made progress in planning to protect their federal employees during an influenza pandemic. For example:"
Date: July 25, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Selected Credentialing Requirements at Seven Medical Facilities Met, but an Aspect of Privileging Process Needs Improvement

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Veterans Affairs (VA) is responsible for determining that over 36,000 physicians working in its facilities have the appropriate professional credentials and qualifications to deliver health care to veterans. To do this, VA credentials and privileges physicians providing care at its medical facilities. In this report, GAO determined the extent to which selected VA facilities complied with (1) four VA credentialing requirements and five VA privileging requirements and (2) a requirement to submit information on paid malpractice claims. GAO also determined (3) whether VA has internal controls to help ensure the accuracy of information used to renew clinical privileges. GAO reviewed VA's policies, interviewed VA officials, and randomly sampled 17 physician files at each of seven VA medical facilities."
Date: May 25, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

VA Health Care: Steps Taken to Improve Practitioner Screening, but Facility Compliance with Screening Requirements Is Poor

Description: A letter report issued by the Government Accountability Office with an abstract that begins "In March 2004, GAO reported on gaps in VA's requirements for screening the professional credentials and personal backgrounds of health care practitioners (GAO-04-566). GAO found that VA's requirements did not ensure thorough screening of VA practitioners. VA concurred with four recommendations GAO made to improve practitioner screening. GAO was asked to determine the extent to which (1) VA has taken steps to improve practitioner screening by implementing GAO's recommendations and (2) VA facilities are in compliance with VA's practitioner screening requirements. GAO reviewed VA's current practitioner screening policies to determine if gaps remain, interviewed VA officials, and sampled about 60 practitioner files at each of seven VA facilities selected based on size and geographic location."
Date: May 25, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Health-Care-Associated Infections: HHS Action Needed to Obtain Nationally Representative Data on Risks in Ambulatory Surgical Centers

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Health-care-associated infections (HAI) are a leading cause of death. Recent high-profile cases of HAIs in ambulatory surgical centers (ASC) due to lapses in recommended infection control practices may indicate a more widespread problem in ASCs, but the prevalence of such lapses is unknown. The Department of Health and Human Services' (HHS) Centers for Medicare & Medicaid Services (CMS) and other entities collect data on HAIs, including process data on the use of recommended practices and outcome data on HAI incidence. CMS conducts standard surveys on about half of ASCs every 3 to 4 years, assessing compliance with its standard on infection control. In this report, GAO examines the availability of data on HAIs in ASCs nationwide. GAO interviewed subject-matter experts, agency officials, and trade and professional group officials."
Date: February 25, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Private Health Insurance Coverage: Expert Views on Approaches to Encourage Voluntary Enrollment

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "To help expand health insurance coverage among the 50 million uninsured Americans, the Patient Protection and Affordable Care Act as amended (PPACA) mandates that individuals, subject to certain exceptions, obtain health insurance coverage or pay a financial penalty beginning in 2014--the "individual mandate". At the same time, PPACA generally requires insurers to accept all applicants, regardless of health status, and prohibits insurers from excluding coverage based on any preexisting conditions. An individual mandate such as PPACA requires has been the subject of continued debate. Many health care policy experts have stressed the importance of a mandate in expanding health care coverage and keeping premiums affordable. For example, experts have noted that such a federal requirement may be necessary to prompt many individuals, such as younger, healthier individuals, to obtain coverage they otherwise would forego--particularly once they are guaranteed access to that coverage later when they may need it. They suggest that bringing these younger, healthier individuals into the insurance market is necessary to avoid adverse selection, whereby disproportionately less healthy individuals who need health care services enroll in coverage, leading to higher premiums that further discourage healthy individuals from enrolling. Some experts have argued that the individual mandate does not go far enough to ensure that all of the uninsured enroll, and that to do so would require heavier penalties that are fully enforced to be truly effective. Other experts suggest that, rather than requiring individuals to obtain health insurance coverage, a more appropriate role for the federal government would be to consider alternatives to encourage voluntary enrollment. Some of these experts also question the legality of a federal mandate. Since its enactment, the federal mandate has been subject to a number of court challenges to its constitutionality. ...
Date: February 25, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Medicare Dialysis Facilities: Beneficiary Access Stable and Problems in Payment System Being Addressed

Description: A letter report issued by the General Accounting Office with an abstract that begins "Medicare covers about 90 percent of patients with end-stage renal disease (ESRD), the permanent loss of kidney function. Most ESRD patients receive regular hemodialysis treatments, a process that removes toxins from the blood, at a dialysis facility. A small percentage dialyzes-at home. From 1991 through 2001, the ESRD patient population more than doubled, from about 201,000 to 406,000. As the need for services grows, so do concerns about beneficiary access to and Medicare payment for dialysis services. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 directed GAO to study beneficiaries' access to dialysis services. In this report, GAO (1) assessed the supply of dialysis facilities and the services they provide, overall and relative to beneficiary residence, and (2) assessed the extent to which Medicare payments for dialysis services are adequate and the methodology is appropriate. In order to assess the supply of dialysis facilities, GAO used Facility Surveys collected by the Centers for Medicare & Medicaid Services (CMS) and outpatient claims, the bills submitted to Medicare by providers of certain outpatient services from 1998 through 2001. To assess the adequacy of Medicare payment and the appropriateness of the payment methodology, GAO used 2001 Medicare cost reports and outpatient claims submitted by freestanding dialysis facilities."
Date: June 25, 2004
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Managing Diabetes: Health Plan Coverage of Services and Supplies

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Diabetes, which afflicts millions of Americans, is a manageable disease whose effects can be mitigated with proper care, regularly received. Experts recommend certain services and supplies for managing diabetes. Because these can be costly, concerns exist about whether individuals with diabetes have access to and receive what they need. Little is known, however, about health plan coverage of diabetes services and supplies. GAO reviewed the extent to which (1) states require insurance policies to cover diabetes services and supplies, (2) health coverage not subject to state requirements includes diabetes services and supplies, and (3) individuals with diabetes ages 18 and older receive services and supplies. GAO analyzed all 50 states' and the District of Columbia's laws and regulations pertaining to diabetes coverage. GAO also obtained from selected health plans providing coverage not subject to state requirements--13 large-employer plans and 3 plans in the Federal Employees Health Benefits Program (FEHBP)--information on coverage of 10 services and nine supplies identified as important for individuals with diabetes. In addition, GAO obtained national data from the Centers for Disease Control and Prevention (CDC) on individuals' receipt of diabetes services and supplies. GAO received technical comments from CDC and incorporated them in the report as appropriate."
Date: February 25, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Federal Assistance: Information on Federal Funds to Suffolk County, New York

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the level of federal assistance provided to Suffolk County, New York, as well as data on incomes and the distribution of population within the county."
Date: June 25, 1999
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Medicare Contracting Reform: Agency Has Made Progress with Implementation, but Contractors Have Not Met All Performance Standards

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 significantly reformed contracting for payment of Medicare's $310 billion per year in fee-for-service claims. The Centers for Medicare & Medicaid Services (CMS) is transitioning claims administration to 19 new entities known as Medicare Administrative Contractors (MAC) and plans to complete the process ahead of October 1, 2011, the date required by law. In 2005, GAO reported that CMS's plan to accelerate the transition could create challenges and was based on estimated costs and savings that were uncertain. In this report GAO examined (1) how CMS has implemented Medicare contracting reform; (2) how CMS assessed the performance of the MACs and what the results of its assessments have been; and (3) what CMS's costs and savings have been for Medicare contracting reform. GAO selected a sample of 6 transitions to review from among the 10 MAC contracts awarded as of June 2008, based on factors such as geographic diversity, volume of claims workload, and transition complexity. GAO analyzed CMS documents related to the MAC transitions, including performance assessments for 3 of the 6 MACs in the sample that had results available for three types of reviews as of March 2009, and interviewed CMS officials, contractors, and provider groups."
Date: March 25, 2010
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Terrorism Insurance: Measuring and Predicting Losses from Unconventional Weapons Is Difficult, but Some Industry Exposure Exists

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Terrorists using unconventional weapons, also known as nuclear, biological, chemical, or radiological (NBCR) weapons, could cause devastating losses. The Terrorism Risk Insurance Act (TRIA) of 2002, as well as the extension passed in 2005, will cover losses from a certified act of terrorism, irrespective of the weapon used, if those types of losses are included in the coverage. Because of a lack of information about the willingness of insurers to cover NBCR risks and uncertainties about the extent to which these risks can be and are being insured by private insurers across various lines of insurance, GAO was asked to study these issues. This report discusses (1) commonly accepted principles of insurability and whether NBCR risks are measurable and predictable, and (2) whether private insurers currently are exposed to NBCR risks and the challenges they face in pricing such risks. GAO collected information from and met with some of the largest insurers in each line of insurance, associations representing a broader cross section of the industry and state insurance regulators. GAO makes no recommendations in this report."
Date: September 25, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department