Washington Highlights: August 27, 2004

GAO Finds Inadequate Oversight of State Medicaid Program Integrity Activities

Contents GAO Finds Inadequate Oversight of State Medicaid Program Integrity Activities NQF Cancer Data and Methods Panel Meets On the Hill Prior Issues August 6, 2004 July 30, 2004 July 23, 2004 July 16, 2004 July 9, 2004 Archive

August 27, 2004 - A recently released report (GAO-04-707) from the Government Accountability Office (GAO) concludes that Centers for Medicare and Medicaid Services (CMS) oversight of state Medicaid program integrity efforts "may be disproportionately small relative to the risk of serious financial loss." The report was submitted to Senate Finance Committee Chairman Charles Grassley (R-Iowa) on July 16.

The GAO study evaluated state Medicaid program integrity activities and CMS oversight of those activities. Describing CMS oversight as "limited," the GAO report found that CMS devoted just $26,000 and eight staff positions to these activities in 2004. While the study commends CMS "for the actions it has begun to take to address its Medicaid financial management challenges," it concludes that CMS has "fallen short in providing the level of oversight required to ensure states' Medicaid financial responsibility." Similarly, the report praises CMS for expanding its financial management resources, yet criticizes it forfailing to indicate "a similar commitment to enhancing its support and oversight of states' program integrity efforts."

Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526

NQF Cancer Data and Methods Panel Meets

The data and methods panel for the National Quality Forum's Cancer Care Project met Aug. 18 to develop recommendations to assist the project's three technical panels 2004. Each panel will evaluate candidate measures in one of the following areas: breast cancer, colon cancer, and symptom management / end-of-life care. The purpose of the project is to achieve consensus on a set of voluntary standards that can be used to assess the quality of cancer care in the United States.

The meeting began by discussing measure indicators that relate to the domains of quality (structure, process, outcomes, patient experience, and access). During this discussion they agreed on several points that included:

• Ensuring that candidate measures have been tested in a robust population and have a strong evidence base;
• Considering factors such as ethnicity, socioeconomic status, age, and gender when reviewing candidate measures;
• Focusing on candidate measures that use intermediate outcomes that are linked to larger goals; and
• Reviewing candidate measures that address different types of chemotherapy.

The panel then discussed the criteria for measure assessment (importance, scientific acceptability, usability, and feasibility). There was significant discussion about risk adjusting measures, and panelists agreed that in certain situations it would be necessary to eliminate or isolate data or to stratify it in order to compensate for any shortcomings in the risk adjustment methodology. Using measures for accountability versus quality improvement was another topic that was discussed, and panel members agreed that this project should consider measures for both purposes.

Information:
Jeff Patyk, Staff Specialist
AAMC Health Care Affairs
jpatyk@aamc.org
(202) 828-0498

On the Hill

The following Members of the 108th Congress have announced plans not to return for the 109th Congress: