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089620 1 (1975-07-03)

handle is hein.gao/gaobacvrd0001 and id is 1 raw text is: NITED STATES GENERAL ACCOUNTING OFFICE REGIONAL OFFICE ROOM 1903 JOHN F. KENNEDY FEDERAL BUILDING GOVERNMENT CENTER BoSTON, MASSACHUSETTS 02203 July 3, 1975 Neil P. Fallon, Regional Commissioner Social and Rehabilitation Service Department of Health, Education, and Welfare John F. Kennedy Building Boston, Massachusetts 02203 Dear Mr. Fallon: The U. S. General Accounting Office (GAO) is reviewing delays in transferring Medicaid and Medicare patients who are deemed medically ready for discharge from hospitals to lower cost health care situations in Massachusetts. We are finding that in addition to paying for medically necessary inpatient hospital days, both programs pay for what are called adminis- tratively necessary (AN) days. Although our review is still in process, we are presenting our findings on some reasons for approving Medicaid AN days in Massachusetts for your information and action. BACKGROUND The Commonwealth Institute of Medicine (the Institute--established by the Massachusetts Medical Society), under a contract with the Common- wealth of Massachusetts, began monitoring hospital stays of Medicaid recipients under the Commonwealth Hospital Admissions Monitoring Program (CHAMP) in October 1973. It has been monitoring Medicaid recipients in all acute care hospitals since June 1974. The Federal Government and Massachusetts share the cost of this program equally. As part of its reporting system, CHAMP keeps records for each hospital of the approved AN days. The principal cause of AN days in Massachusetts from July to November 1974, was the lack of appropriate lower health care beds--1,047 days out of 3,016 days for the 5-month period. Although our review is not completed, we believe that some of the causes for AN days could be eliminated and this would help. reduce Medicaid costs. ea7~o

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