Politics & policy

Insight into federal and state health care legislation & CMS regulation

HHS Report: HCFA Is Not Keeping Up On Managed Care

The Health Care Financing Administration isn't keeping up to date with changes in the Medicare managed care industry, says a new report from the Office of the Inspector General in the Department of Health and Human Services. The fallout, according to the report, is that HCFA cannot assess the extent to which plans limit access to, and use of, services.

HCFA has "no formal mechanisms to keep up with plan activities between reviews, nor is it sufficiently flexible to respond to the changes in the marketplace or even to the characteristics of specific plans and the differences among them," the OIG report said. HCFA now performs a standardized, formal on-site review of health plans every two years.

The report concludes that HCFA doesn't receive enough data from managed care plans in a constantly evolving market — especially when compared to fee-for-service operations. For example, OIG said, the agency receives beneficiary encounter and utilization data and provider profiles under fee-for-service medicine, but not under managed care.

OIG urged HCFA to "make better use of data as a key element for ongoing contact and oversight of plan activities." Furthermore, the report said, "the demands and challenges of the new Medicare+Choice program make steps such as these even more critical."

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