STATUS OF IMPLEMENTATION OF MEDICAID F . M-1433 ‘- INSTITUTIONAL UTILIZATION CONTROL 3mz7. REQuIR~ENTS~,fr~,i.'/::,' . i ; I,,* ': :,.-y," .; ; , [ : ,i ,i ,‘. /j HRD-77-56 _ ...-_-....-.-_ I RESTRICTED _, ___.i;l:--&.-.~ ” J IIlllllllllllllllllllllllllllllllllll LM100516 Pursuant to a request from Chairman, Subcommittee on Oversight : I1 and Investigation.s, House Committee on Interstate and Foreign Commerce, --y$& f ; ,I\ I_'.! /(_jl , $&,:.?, .j : +;, ; :,'<." .,- we reviewed,'HEW and States compliance with section 1903(g) of the Social Security Act. - . Section 1903(g)(l) requires each State to submit a quarterly showing (certification) that it has an effective program of utilization ‘. control over long-term institution care. HEW must validate States' certifications by at least conducting on-site sample surveys at medical facilities with Medicaid recipients. +-7 Q6: t&d Wey;lave-=d,e~~rm~nned.that: . -All States except Delaware have submitted all required certifications of compliance for the quarters starting April 1 and July 1, 1976. As a result, Delaware's grant award for long-term care in mental hospitals were reduced for the quarter starting April 1, 1976. -HEW has sent disallowance letters to three States indicating a total amount of $122,371 to be reduced from the States' grant awards for not submitting the required certifications for the fiscal year 1975 validation survey. -HEW should request more information from States as evidence of having an effective program of utilization control. -The HEW validation survey for fiscal year 1975 was very limited in scope. . \ I , V . .’ - We recommended that Congress should amend the law to improve a specific timeframe within which the Secretary must conduct validation surveys. We also reported that Congress should amend the provision in 1903(g)(l) to set an adherence level of less than 100 percent. We made recommendations to the Secretary of HEW with respect to including . . visits to institutions on a sample basis as required by law and revise -
Status of Implementation of Medicaid Utilization Control Requirements
Published by the Government Accountability Office on 1977-03-01.
Below is a raw (and likely hideous) rendition of the original report. (PDF)