Congressional Documents
GAO report suggests HHS address contractor performance and plan for needed measures
Posted on January 30, 2012
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed the Department of Health and Human Services (HHS) to enter into a 4-year contract with an entity to perform various activities related to health care quality measurement. In January 2009, HHS awarded a contract to the National Quality Forum (NQF), a nonprofit organization that endorses health care quality measures—that is, recognizes certain ones as national standards. In 2010, the Affordable Care Act (ACA) established additional duties for NQF. This is the second of two reports MIPPA required GAO to submit on NQF’s contract with HHS. In this report—which covers NQF’s performance under the contract from January 14, 2010, through August 31, 2011—GAO examines (1) the status of projects under NQF’s required contract activities and (2) the extent to which HHS used or planned to use the measures it has received from NQF under the contract to meet its quality measurement needs, as of August 2011. GAO interviewed NQF and HHS officials, reviewed relevant laws, and reviewed HHS and NQF documents.
GAO recommends HHS: (1) use all monitoring tools required under the contract to help address NQF’s performance, (2) complete testing of retooled measures, and (3) comprehensively plan for its quality measurement needs. HHS neither agreed nor disagreed with these recommendations. NQF concurred with many of the findings in the report and provided additional context.
GAO compares PCIP implementation with CHIP
Posted on December 15, 2011
The U.S. Government Accountability Office (GAO) has issued a report comparing the early stages of the federal Pre-Existing Condition Insurance Plan (PCIP) with the Children’s Health Insurance Program (CHIP). The federal PCIP was authorized by the Affordable Care Act (ACA), and is intended to provide insurance for individuals with previously existing medical conditions who have been unable to obtain health insurance coverage for at least 6 months. GAO was tasked by the Senate with comparing early enrollment and implementation across both PCIP and CHIP. GAO found that like CHIP, enrollment in PCIP was slow in the beginning, but increased over time. GAO also found that enrollment in PCIP was generally lower in States that had high risk pools than in States that did not.
For more information on pre-existing conditions, click here.
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CRS issues report regarding presidential power over the ACA
Posted on November 15, 2011
On November 14, 2011, the Congressional Research Service issued a memorandum regarding the extent to which a President, through use of an executive order or other administrative actions, could impact provisions under the Affordable Care Act (ACA). The report confirms that while the President would be able to alter certain regulations, a “President would not appear to be able to issue an executive order halting an agency from promulgating a rule that is statutorily required by PPACA, as such an action would conflict with an explicit congressional mandate…” CRS examined the issue for Republican Senator Tom Coburn of Oklahoma, finding that federal courts would frown upon any attempt to undo White House legislation.
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GAO recommends automatic increases in FMAP
Posted on November 10, 2011
A recent Government Accountability Office (GAO) report introduces a prototype formula to provide states with temporary Medicaid assistance during national economic downturn. Once a threshold number of states–26 in the GAO formula–demonstrate a sustained decrease in their employment-to-population ratio, temporary increases to the Federal Medical Assistance Percentage (FMAP) will be automatically triggered under the GAO plan. This assistance will end when fewer than the threshold number of states show a decline in the ratio. Targeted state assistance would be calculated based on 1) increases in unemployment, as a proxy for changes in Medicaid enrollment; and 2) reductions in total wages and salaries, as a proxy for changes in states’ revenues. Such assistance would facilitate state budget planning, provide states with greater fiscal stability, and better align federal assistance with the magnitude of the economic downturn’s effect on individual states.
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CRS paper identifies potential issues with MAGI redefinition
Posted on October 25, 2011
The Congressional Research Service (CRS) released a paper pertaining to Congress’s moves to redefine modified adjusted gross income (MAGI) to include Social Security income. CRS cites three issues that Congress should consider if the definition of income is changed. First, because MAGI can be computed largely from federal tax return information, verification of income is streamlined. Thus, by including additional provisions, there will be increased administrative complexity involved with calculating an individual’s MAGI. Second, the original definition was developed to promote coordination between Medicaid and premium credits in the health insurance exchange. Thus, this definition change should not only apply to income definition for Medicaid, but also should apply to premium credits. Third, bill proposals have focused largely on the inclusion of Social Security benefits in MAGI for eligibility purposes. However, many other low-income programs include other types of income and asset holdings that are also excluded from MAGI.
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CRS releases report comparing health insurance coverage across states
Posted on October 20, 2011
The Congressional Research Service (CRS) recently released the report “Health Insurance Coverage by State and Congressional District, 2010,” which employs the U.S. Census Bureau’s 2010 American Community Survey (ACS) to describe health insurance coverage and provide estimates of coverage by type at the national, state, and congressional district level. The report details the considerable differences in insurance status and coverage source across states, within states, and across demographic groups.
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GAO makes recommendations to CMS regarding oversight of long-term care hospitals
Posted on October 17, 2011
The United States Government Accountability Office (GAO) released a report, “Long-Term Care Hospitals: CMS Oversight is Limited and Should Be Strengthened,” which recommends that the Centers for Medicare & Medicaid Services (CMS) strengthen its oversight of long-term care hospital (LTCH) survey activities and improve data collection on quality of care. LTCHs specialize in the provision of care to individuals with multiple or chronic conditions. CMS does currently collect data on the quality of care at LTCHs, but the GAO argues that the data are limited for several reasons. First, CMS does not have detailed data on survey results conducted by The Joint Commission (TJC) prior to 2009. Second, CMS does not currently collect data on LTCH quality measures regarding health care delivery because LTCHs are not required to report them. However, under the ACA, LTCHs will be required to make such reports beginning in 2014.
GAO paper recommends improved health care price transparency
Posted on September 24, 2011
Consumers are responsible for increasing proportions of their health care costs. Health care price information that is available before consumers receive care, or transparent, may help consumers anticipate such costs. In a recently released report, the U.S. Government Accountability Office (GAO) examined 1) how various factors affect the availability of health care price information for consumers and 2) the information selected public and private health care price transparency initiatives make available to consumers. GAO reviewed price transparency literature, interviewed experts, and examined eight federal, state, and private insurance company health care price transparency initiatives. The report recommends that the Department of Health and Human Services (HHS) determine the feasibility of making complete cost estimates of health care consumers available to consumers.
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GOP issues report on CLASS Act
Posted on September 16, 2011
House and Senate Republicans have issued a new report on the Community Living Assistance Services and Supports (CLASS) program, a long-term care insurance program created by the Affordable Care Act (ACA). The report, “CLASS’ UNTOLD STORY: Taxpayers, Employers, and States on the Hook for Flawed Entitlement Program,” was issued by the bicameral Repeal CLASS Working Group, and calls for the repeal of the CLASS program due to questions surrounding its financial sustainability.
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CRS issues report on individual mandate under ACA
Posted on August 24, 2011
The Congressional Research Service (CRS) has released a report on the individual requirement to purchase health insurance (individual mandate) under the Affordable Care Act (ACA). The report, “Individual Mandate and Related Information Requirements under PPACA,” lays out the various exemptions granted from the individual mandate provisions under the law, as well as explains how enforcement of the mandate by the IRS will work once the mandate takes effect in 2014.
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