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According addition adequate administrator agree ahcccs health plans ahcccs program ahcccs's areas Arizona assess assistance assurance audits awarded awarded contracts basis believe beneficiaries bid prices bidders Budget choice claims collection Comments complete compliance Conclusions condition Containment contract award contractors contracts costs counties Department of Health determine develop disclosure discussed effectiveness eligibility enrollment ensure establish estimated evaluation example experience Family federal fee-for-service Financial Performance financial reporting funds hcfa health care health care services hmos Human implementing improved incentive increased information system limited lowest mcauto Medicaid Medicaid agency ment monitoring months needed noted officials operations organizations oversight paid participate payments penalties percent period Physicians population possible prepaid health plans price competition problems procurement qualified reasonable received recipients recommendations reduce regulations reporting requirements responsibility result risk serve specific standards submit tion utilization data
Page 10 - January 1, 1966, under authority of title XIX of the Social Security Act, as amended (42 USC 1396).
Page 55 - ... revenues and expenditures applicable to agency operations are recorded and accounted for properly so that accounts and reliable financial and statistical reports may be prepared and accountability of the assets may be maintained. The internal control standards we developed for executive agencies to follow include a requirement that the internal control systems provide reasonable assurance that the systems' objectives will be accomplished.
Page 10 - Cash payments come mainly from the Aid to Families with Dependent Children (AFDC) and Supplemental Security Income (SSI) programs.
Page 47 - ... that Federal health care dollars are not diverted to uses other than the delivery of services. This has special applicability with regard to HMOs, Health Insuring Organizations (HIOs), and other prepaid health plans participating in Medicaid. As the GAO noted in a recent report to the Subcommittee, "Related-party transactions within these corporate structures can enable health plans to divert capitation funds from their intended purpose — the provision of health care. They can lead to unnecessary...
Page 61 - ... date. (4) The HMO or ШО has provided the information on physician incentive plans listed in §417.479(h)(3) of this chapter to any Medicaid recipient who requests it. (b) HCFA may withhold FFP for any period during which — (1) The State fails to meet the State plan requirements of this part; (2) Either party to a contract substantially fails to carry out the terms of the contract; or (3) The State fails to obtain from each HMO or...
Page 55 - ... considered in determining whether there is reasonable assurance the control objectives are being achieved.) GAO Standards for Internal Control in the Federal Government (June 1983) The standard of reasonable assurance recognizes that the cost of internal control should not exceed the benefit derived. Reasonable assurance equates to a satisfactory level of confidence under given considerations of costs, benefits, and risks. The required determinations call for judgment to be exerc i sed.
Page 41 - Arizona Medicaid: Nondisclosure of Ownership Information by Health Plans (GAO/HRD-8610, Nov. 22, 1985); Medicaid: Lessons Learned From Arizona's Prepaid Program (GAO/HRD-8714, Mar. 6, 1987); Medicaid: Early Problems in Implementing in Implementing the Philadelphia HealthPASS Program (GAO/HRD-88-37, Dec.
Page 44 - Federally- funded repetition of these problems, you identified 11 requirements: (1) sufficient time should be allowed between program authorization and implementation to permit development of adequate financial and utilization reporting systems and program controls; (2) plan failures should be anticipated and contingency plans developed to provide uninterrupted services to beneficiaries; (3) health plan procurements should be designed to promote maximum competition and cost savings; (4) minimum requirements...