government

Medicaid spending not adequately monitored by CMS, GAO says

NEWS IN BRIEF — Posted Aug. 16, 2010

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The Centers for Medicare & Medicaid Services has been inconsistent in verifying if states are paying Medicaid managed care plans on a sound actuarial basis, according to a Government Accountability Office report released in August.

The GAO found that CMS had not reviewed Tennessee's Medicaid rate setting for multiple years when it determined that the state received about $5 billion a year in funds that had not been certified by an actuary, a requirement of states. The agency also had not reviewed Nebraska's rates since the actuarial soundness requirements took effect.

The GAO reviewed CMS oversight for 26 of the 34 states with comprehensive managed care programs, accounting for about 85% of managed care enrollment. The Dept. of Health and Human Services agreed with the recommendations of the GAO report, which is available online (link).

Note: This item originally appeared at http://www.ama-assn.org/amednews/2010/08/16/gvbf0816.htm.

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