The Government Accountability Office and the federal advisory panel on Medicaid reiterated their calls Tuesday for states to better document and report the extra payments they make to providers that fall outside the federal disproportionate-share hospital programs.
The lack of transparency, the GAO says, limit the federal government's ability to make sure the payments are efficient and actually support Medicaid beneficiaries. In one analysis, the agency found that supplemental payments to about 500 hospitals in 39 states exceeded the costs of caring for Medicaid patients by $2.7 billion.
The GAO is also concerned that states are increasingly relying on collecting assessments from providers and local governments to draw federal matching dollars and create funding for enhanced Medicaid payments. Such programs, the GAO found in a report last year, financed about 26% of the nonfederal share of Medicaid spending in 2012.
“We continue to believe that improved data are needed to improve transparency and oversight, such as to understand how increased federal costs may affect beneficiaries and the providers who serve them,” Katherine Iritani, director of the GAO's healthcare team, said during a hearing before the House Energy and Commerce Committee's Subcommittee on Health.
HHS was not represented by a witness during Tuesday's hearing. ">According to a GAO report issued in June
Rep. Larry Bucshon (R-Ind.) questioned the need for more reporting and oversight. “The federal government wants to micromanage the states,” he said.
But the Medicaid and CHIP Payment and Access Commission, an independent congressional advisory panel, has also called for more reporting from states. Anne Swartz, MACPAC's executive director, said at the hearing Tuesday that hospital-specific data for all types of Medicaid payments to hospitals, as well as on the sources of the nonfederal share, are necessary to determine net Medicaid payments at the provider level.
“Efforts to fully understand provider payment levels is more relevant now than at any time in the program's history,” Swartz said. “Interest in payment reforms that incentivize greater value in the delivery of health services is also growing. Even so, lack of solid data on net payments makes it extremely difficult to assess the effectiveness of these efforts.”
Rep. Lynn Jenkins (R-Kan.) also appeared before the committee to speak in favor or her bill to further delay implementation of Medicare's direct supervision requirement for certain outpatient procedures at rural and critical access hospitals.
A companion bill has passed the Senate. Both would push enforcement into 2016.
“Most of these outpatient procedures are relatively simple, are very safe, and would not benefit from a federal mandate that a physician always be in the room,” Jenkins said. “And, as a practical matter, in rural hospitals across America, such a requirement is simply not feasible.”
