The federal government needs to do a better job of verifying that hospitals and other providers are meeting the criteria to qualify for special Medicare and Medicaid funding available through the electronic health record program created by the American Recovery and Reinvestment Act of 2009.

This is one the conclusions reached by the U.S. Government Accountability Office(GAO) in a recently released report titled First Year of CMS’s Incentive Programs Shows Opportunities to Improve Processes to Verify Providers Met Requirements.

To improve verification, GAO recommends that Medicare evaluate its current approach to auditing provider eligibility; conduct more verifications; collect additional information from providers when they attest to their eligibility for the funding; and give the states the option of having the federal government collect eligibility data for state Medicaid electronic health record funding.

Read a more detailed summary of the GAO report and download the entire report here, on the GAO web site.…

Medicaid will increase its matching rate for states that offer qualified services in the home or community for dual eligible recipients who might otherwise require nursing home or other institutional care.

The Community First Choice program, created under the Affordable Care Act, will increase the federal Medicaid matching rate by six percentage points for home- and community-based services that meet specific federal criteria.

Find a Department of Health and Human Services news release and fact sheet with further information about the new program here.…

Enrollment is playing a greater role than health care inflation in the rise of federal health care spending, according to a new study by the Urban Institute.

“Medicare, Medicaid and the Deficit Debate” notes that the rise in annual health care costs is now tracking closer to rising gross domestic product (GDP) than it has in the past and that the combination of growing numbers of baby boomers newly eligible for Medicare and increasing Medicaid enrollment spurred by the weak economy are more central to rising federal health care spending than health care inflation.

Read a summary of “Medicare, Medicaid and the Deficit Debate” and download the complete report here, on the Urban Institute’s web site.…

A new analysis concludes that spending more money on primary care for Medicare patients could reduce overall Medicare spending by reducing demand for inpatient and post-acute care.

In fact, the analysis suggests that every additional dollar spent on primary care for Medicare patients will save six dollars in costs for other Medicare services.

Learn more about the analysis presented in the article “Paying More for Primary Care:  Can it Help Bend the Medicare Cost Curve?” by reading this Commonwealth Fund report.…

Approximately 70 percent of Medicaid beneficiaries today are served by Medicaid managed care plans.  States have increasingly turned to managed care over the years to serve their Medicaid beneficiaries, reasoning that such an approach saves money and improves access to care.

But one state – Connecticut – disagrees.

On January 1, Connecticut severed its relationships with managed care plans and began paying for Medicaid services on a fee-for-service basis.  State officials believe this will save them money and, with the addition of case management services, improve care for its Medicaid population.

Read why Connecticut is bucking such a strong nation-wide trend in this Stateline report.…