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090007 1 (1973-11-14)

handle is hein.gao/gaobacvvv0001 and id is 1 raw text is: z oUNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 MANPOWER AND WELFARE 1 DIVISION Mr. James B. Cardwell Commissioner of Social Security Department of Health, Education, and Welfare Dear Mr. Cardwell: We are performing a survey of the manner in which independent laboratories are regulated and reimbursed under four federally funded health programs--Medicare, Medicaid, the Federal Employees Health Benefits Program, and the Civilian Health and Medical Program of the Uniformed Services. During the survey, we noted that there are con- siderable delays by the Bureau of Health Insurance (BHI) headquarters in acting on recommendations from BHI regional offices that indepen- dent laboratories' certification for participation under Medicare be terminated (decertified), either entirely or for certain laboratory specialties. To help assure the health and safety of Medicare patients who obtain laboratory services, laboratories must be certified by BHI to be eligible to participate under Medicare. Under agreements entered into with the Secretary of HEW pursuant to title XVIII of the Social Security Act, State agencies determine whether independent laboratories meet the conditions for participation under Medicare. On the basis of determinations by State agencies that independent laboratories meet the conditions for participation, the BHI regional offices send the laboratories a written notice of certification. The State agencies also resurvey laboratories to ascertain continued compliance with requirements for participating in Medicare. When a State agency determines that a laboratory certified to partici- pate under Medicare is out of compliance with requirements for such participation to such an extent that the laboratory should be decertified, the State agency recommends decertification to the BHI regional office. Such recommendations are to be made by the State agency if a laboratory I , b a lluIIH IIII glmll. .t .un.IIIIIIIIIIIIIIIIIIIIII..u.m..l.IIII.llll

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