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DOCIJIZIT RESURE
07q25 - (C2978063]
Ohio's Hedicaid Program: Problems Identified Can Have National
Importance. HRD-78-98A; B-164031(3). October 23, 1978. 11 pp.
Report to Secretary, Department of Health, Education, and
Welfare; by Elmer B. Staats, Comptroller General.
Issue &rea: Health Programs: Compliance Eith Financing Lawa and
Regulations (1207).
Contact: Human Resources Div.
Budget Function: Health: General Health Financing Assistance
(555).
Organization Concerned: Social Security Idministration; Ohio.
Congressional Relevance: House Committee on Interstate and
Foreign Commerce; Senate Committee on Finance.
A comprehensive review of Ohio's modicaid program
ilentified two issues that may have national importance: (1) the
misleading statistics reported by the sedicaid quality control
program which overstate pot6,ntial savinge available from
eliminating eligibility determination errors; and (2) the
unavailability of skilled narsing services to medicaid patie ts
which results in unnecessary hospital expenditures.
Findings/Conclusions: Ohio uses a quality control system
developed by the Department of Health, Education, ahd Welfare
(HEW) to help insure proper and correct expenditures of public
assistance funds by identifying unacceptable performance and
iaeftective policies and taking corrective action. A review of
cases found ineligible by Ohio's quality control review showed
that determinations were generally correct, but the procedures
HEW requires the States to use do not differentiate between
technical and substantive errors. Therefore, true program losses
due to ineligibility and potential savings available from
eliminating eligibility determination errors are overstated. The
availL olity of skilled nursing facility (SNP) services to
medicaid And medicare patients in Ohio has been adversely
affected becaase of the Stats's relatively low limits on SNP
reimbursement. Recommendations: The Administrator of the Health
Care Financing Administration should: revise medicaid quality
control study procedures to include, in reporting results of
these studies, an estimate of potential savings available from
elimination of medicaid eligibility determination errors; arsist
Ohio in improving its reimbursement system for skilled nursing
services in order to increase their availability; and determine
if other States' reimbursement systems for SIFs are resulting in
problems like those in Ohio and assist any State with these
problems in improving their skilled nursing services program.
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