COVID-19 Tests Drove an Increase in Total Medicare Part B Spending on Lab Tests in 2020, While Use of Non-COVID-19 Tests Decreased Significantly
Medicare Part B spent $1.5 billion on COVID-19 tests in 2020, while at the same time, spending on non-COVID-19 tests declined by $1.2 billion. The result was a net spending increase of 4 percent, but the decrease in utilization of non-COVID-19 tests raises questions about the potential impacts on beneficiary health.
Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic
On March 13, 2020, the President of the United States declared that the COVID-19 pandemic was a national emergency. That same day, in accordance with section 1135(b) of the Social Security Act (the Act), the Secretary of HHS invoked his authority to waive or modify certain requirements of Titles XVIII, XIX, and XXI of the Act. To limit the spread of the virus, Federal, State and local governments urged individuals to stay at home and for individuals who test positive to quarantine, among other preventive measures. As a result, the usual and customary ways that many individuals obtained...
Six of Eight Home Health Agency Providers Had Infection Control Policies and Procedures That Complied With CMS Requirements and Followed CMS COVID-19 Guidance To Safeguard Medicare Beneficiaries, Caregivers, and Staff During the COVID-19 Pandemic
Medicare beneficiaries receiving home health services may be at a high risk of developing severe illness from COVID-19. Home health agencies (HHAs) must comply with the Centers for Medicare & Medicaid Services' (CMS's) infection prevention and control requirements and follow CMS guidance by having policies and procedures to protect HHA staff, Medicare beneficiaries, and caregivers during the pandemic. Our objective was to determine whether eight selected HHAs had infection control policies and procedures that complied with CMS requirements and followed CMS guidance to safeguard HHA staff...
Indian Health Service Use of Critical Care Response Teams Has Helped To Meet Facility Needs During the COVID-19 Pandemic
Coronavirus disease 2019 (COVID-19) is a highly contagious, sometimes fatal, disease that has disproportionately affected American Indians and Alaska Natives (AI/ANs). IHS and Tribal health care facilities are the main health care providers for the AI/AN population. Prior OIG work found that IHS facilities often lacked sufficient staff and had limited access to clinical specialists, as well as finding other quality-of-care concerns. One recent IHS effort to address staffing and quality concerns is its development of Critical Care Response Teams (CCRTs) to support IHS and Tribal facilities in...
Medicare Beneficiaries Hospitalized With COVID-19 Experienced a Wide Range of Serious, Complex Conditions
Coronavirus disease 2019 (COVID-19) has affected millions of Americans, resulting in more than 600,000 deaths. Medicare beneficiaries have been particularly affected and remain vulnerable to new variants and additional surges of the virus. Clinicians and researchers are still working to fully understand the damage to the body from the disease and what underlying chronic conditions potentially lead to more severe complications or hospitalization. Understanding the types of conditions for which Medicare beneficiaries with COVID-19 are being treated and who was more likely to be hospitalized with...
CMS's COVID-19 Data Included Required Information From the Vast Majority of Nursing Homes, but CMS Could Take Actions To Improve Completeness and Accuracy of the Data
The United States currently faces a nationwide public health emergency because of the COVID-19 pandemic. Federal regulations, effective May 8, 2020, required nursing homes to report COVID-19 information, such as the number of confirmed COVID-19 cases among residents, at least weekly to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network. Each week, CDC aggregates the reported information and sends the data to the Centers for Medicare & Medicaid Services (CMS) for posting to the CMS website. These data are used to assist with national surveillance of...
States’ Backlogs of Standard Surveys of Nursing Homes Grew Substantially During the COVID-19 Pandemic
States’ backlogs of standard nursing home surveys have grown substantially, even after August 2020 when CMS lifted its suspension of those surveys (which it had suspended due to the COVID-19 pandemic). Nationally, 71 percent of nursing homes had gone at least 16 months without a standard survey as of May 31, 2021. The rising backlogs add urgency to our existing recommendation that CMS clarify expectations and provide guidance to States on completing these important surveys.
CMS's Controls Related to Hospital Preparedness for an Emerging Infectious Disease Were Well-Designed and Implemented but Its Authority Is Not Sufficient for It To Ensure Preparedness at Accredited Hospitals
CMS’s Controls Related to Hospital Preparedness for an Emerging Infectious Disease Were Well-Designed and Implemented but Its Authority Is Not Sufficient for It To Ensure Preparedness at Accredited Hospitals
Hospitals that cannot control the spread of emerging infectious diseases within their facilities risk spreading a disease such as COVID-19 to patients and staff. OIG therefore developed a plan to assess the Centers for Medicare & Medicaid Services’ (CMS’s) controls related to hospital preparedness for emerging infectious diseases.The objective of this audit was to determine whether CMS designed and implemented effective internal controls related to hospital preparedness for emerging infectious diseases such as COVID-19.