Medical Billing Companies

Effective Use Of Medicaid

The Centers for Medicare and Medicaid Services (CMS) has taken the necessary steps in ensuring enough incentives for the states. This ensures that the billions of dollars received for the provision of Medicaid Managed Long Term Services and Supports (MLTSS) are put to use effectively. The Government Accountability Office (GAO) has made this official through their findings in a recent report.

Nonetheless, the GAO stated that the MLTSS programs could allow the states to increase the community-based care and lower association costs, if the designs for the payment structures are proper. They also added that CMS does not always require the states to report on the achievability of the program goals through payment structures like payment rates, incentive payments, and penalties.

The report also laid down a few recommendations for the CMS. This primarily included the states to report on their advancement in accomplishing the MLTSS program goals. These recommendations have also been agreed by the Department of Health and Human Services.

The report by GAO also carried many concerns regarding the appropriateness and reliability of the data, which states used to set MLTSS rates. According to authors behind the reports, “To the extent that states use data that are not appropriate and reliable to set rates, the resulting rates could be too low, which could provide an incentive for [managed care organizations] to reduce care, or too high, which results in more federal spending than necessary.”

Professional Medical Billing

MLTSS Program Provisions

It is believed that the requirements of CMS will be increased in the upcoming months. The agency will require states to validate the encounter data in July. However, for the various state procedures, CMS has not yet released any regulations along with the minimum standards required. The GAO has said that such recommendations put forward to the agency will definitely aid in minimizing the risk of encounter data being incomplete or inaccurate.

The preparation of this report by the GAO has been carried out at the request of some of the members of the congress. For this, a review of the most significant federal regulations, guidance, and internal control standards were carried out. The program information in six states, including Arizona, Delaware, Florida, Kansas, Minnesota, and Texas were reviewed for this purpose. Interviews were also carried out on CMS and Medicaid officials from the selected states.

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