If you are looking for the sweeping Medicare and Medicaid changes in the new balanced budget act, you came to the wrong place. The Act is so long, it got its own page.

Or you can flip directly to the subtitles by using this table of contents:

• Subtitle A--Medicare+Choice Program
• Subtitle B--Prevention Initiatives
• Subtitle C--Rural Initiatives
• Subtitle D--Anti-Fraud and Abuse Provisions and Improvements in Protecting Program Integrity
• Subtitle E--Provisions Relating to Part A Only
• Subtitle F--Provisions Relating to Part B Only
• Subtitle G--Provisions Relating to Parts A and B
• Subtitle H--Medicaid
• Subtitle I--Programs of All-Inclusive Care for the Elderly (PACE)
• Subtitle J--State Children's Health Insurance Program

• Medicare Program; Medicare Appeals of Individual Claims, [Federal Register: May 12, 1997 (Volume 62, Number 91)] [Rules and Regulations] [Page 25844-25855]. This rule expands our regulations to recognize the right of Part B appellants to a hearing before an administrative law judge (ALJ) for claims if at least $500 remains in dispute and the right to judicial review of an adverse ALJ decision if at least $1,000 remains in controversy.
• Medicare Program; Establishment of an Expedited Review Process for Medicare Beneficiaries Enrolled in Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans, [Federal Register: April 30, 1997 (Volume 62, Number 83)] [Rules and Regulations] [Page 23368-23376]. This final rule with comment period establishes a new administrative review requirement for Medicare beneficiaries enrolled in health maintenance organizations (HMOs), competitive medical plans (CMPs), and health care prepayment plans (HCPPs).

• 42 USC CHAPTER 7, SOCIAL SECURITY BENEFITS Links to 42 USC Sec. 301 to 1397f courtesy of the Legal Information Institute of Cornell University. Selected links follow.
• 42 USC Sec. 405. Evidence, procedure, and certification for payments
• 42 USC Sec. 426. Entitlement to hospital insurance benefits
• 42 USC Sec. 426a. Transitional provision of eligibility of uninsured individuals for hospital insurance benefits
• 42 USC Sec. 1383c. Eligibility for medical assistance of aged, blind, or disabled individualsunder State's medical assistance plan
• 42 USC Sec. 1395. Prohibition against any Federal interference
• 42 USC Sec. 1395a. Free choice by patient guaranteed
• 42 USC Sec. 1395b. Option to individuals to obtain other health insurance protection
• 42 USC Sec. 1395b-1. Incentives for economy while maintaining or improving quality inprovision of health services
• 42 USC Sec. 1395b-2. Notice of medicare benefits
• 42 USC Sec. 1395b-3. Health insurance advisory service for medicare beneficiaries
• 42 USC Sec. 1395b-4. Health insurance information, counseling, and assistance grants
• 42 USC Sec. 1395c. Description of program
• 42 USC Sec. 1395d. Scope of benefits
• 42 USC Sec. 1395e. Deductibles and coinsurance
• 42 USC Sec. 1395f. Conditions of and limitations on payment for services
• 42 USC Sec. 1395g. Payments to providers of services
• 42 USC Sec. 1395h. Use of public or private agencies or organizations to facilitate payment
• 42 USC Sec. 1395i. Federal Hospital Insurance Trust Fund
• 42 USC Sec. 1395i-1. Authorization of appropriations
• 42 USC Sec. 1395i-2. Hospital insurance benefits for uninsured elderly individuals not otherwise eligible
• 42 USC Sec. 1395i-2a. Hospital insurance benefits for disabled individuals who have exhausted other entitlement
• 42 USC Sec. 1395i-3. Requirements for, and assuring quality of care in, skilled nursing facilities
• 42 USC Sec. 1395i-4. Essential access community hospital program
• 42 USC Sec. 1395j. Establishment of supplementary medical insurance program for aged anddisabled
• 42 USC Sec. 1395k. Scope of benefits; definitions
• 42 USC Sec. 1395l. Scope of benefits; definitions
• 42 USC Sec. 1395m. Special payment rules for particular items and services
• 42 USC Sec. 1395n. Procedure for payment of claims of providers of services
• 42 USC Sec. 1395o. Eligible individuals
• 42 USC Sec. 1395p. Enrollment periods
• 42 USC Sec. 1395q. Coverage period
• 42 USC Sec. 1395r. Amount of premiums for individuals enrolled under this part
• 42 USC Sec. 1395t. Federal Supplementary Medical Insurance Trust Fund
• 42 USC Sec. 1395u. Use of carriers for administration of benefits
• 42 USC Sec. 1395v. Agreements with States
• 42 USC Sec. 1395w. Appropriations to cover Government contributions and contingency reserve
• 42 USC Sec. 1395w-1. Physician Payment Review Commission
• 42 USC Sec. 1395w-2. Intermediate sanctions for providers or suppliers of clinical diagnostic laboratory tests
• 42 USC Sec. 1395w-3. Repealed.
• 42 USC Sec. 1395w-4. Payment for physicians' services
• 42 USC Sec. 1395x. Definitions
• 42 USC Sec. 1395y. Exclusions from coverage and medicare as secondary payer
• 42 USC Sec. 1395z. Consultation with State agencies and other organizations to develop conditions of participation for providers of services
• 42 USC Sec. 1395aa. Agreements with States
• 42 USC Sec. 1395bb. Effect of accreditation
• 42 USC Sec. 1395cc. Agreements with providers of services
• 42 USC Sec. 1395dd. Examination and treatment for emergency medical conditions and women in labor
• 42 USC Sec. 1395ee. Practicing Physicians Advisory Council
• 42 USC Sec. 1395ff. Determinations of Secretary
• 42 USC Sec. 1395gg. Overpayment on behalf of individuals and settlement of claims for benefits on behalf of deceased individuals
• 42 USC Sec. 1395hh. Regulations
• 42 USC Sec. 1395ii. Application of certain provisions of subchapter II
• 42 USC Sec. 1395jj. Designation of organization or publication by name
• 42 USC Sec. 1395kk. Administration of insurance programs
• 42 USC Sec. 1395ll. Studies and recommendations
• 42 USC Sec. 1395mm. Payments to health maintenance organizations and competitive medical plans
• 42 USC Sec. 1395nn. Limitation on certain physician referrals
• 42 USC Sec. 1395oo. Provider Reimbursement Review Board
• 42 USC Sec. 1395pp. Limitation on liability where claims are disallowed
• 42 USC Sec. 1395qq. Indian health service facilities
• 42 USC Sec. 1395rr. End stage renal disease program
• 42 USC Sec. 1395ss. Certification of medicare supplemental health insurance policies
• 42 USC Sec. 1395tt. Hospital providers of extended care services
• 42 USC Sec. 1395uu. Payments to promote closing or conversion of underutilized hospital facilities
• 42 USC Sec. 1395vv. Withholding payments from certain medicaid providers
• 42 USC Sec. 1395ww. Payments to hospitals for inpatient hospital services
• 42 USC Sec. 1395xx. Payment of provider-based physicians and payment under certain percentage arrangements
• 42 USC Sec. 1395yy. Payment to skilled nursing facilities for routine service costs
• 42 USC Sec. 1395zz. Medicare and medigap information by telephone
• 42 USC Sec. 1396a. State plans for medical assistance
• 42 USC Sec. 1396b. Payment to States
• 42 USC Sec. 1396c. Operation of State plans
• 42 USC Sec. 1396d. Definitions
• 42 USC Sec. 1396e. Enrollment of individuals under group health plans
• 42 USC Sec. 1396f. Observance of religious beliefs
• 42 USC Sec. 1396g. State programs for licensing of administrators of nursing homes
• 42 USC Sec. 1396g-1. Required laws relating to medical child support
• 42 USC Sec. 1396h. Transferred
• 42 USC Sec. 1396i. Certification and approval of rural health clinics and intermediate care facilities for mentally retarded
• 42 USC Sec. 1396j. Indian health service facilities
• 42 USC Sec. 1396k. Assignment, enforcement, and collection of rights of payments for medical care; establishment of procedures pursuant to State plan; amounts retained by State
• 42 USC Sec. 1396l. Hospital providers of nursing facility services
• 42 USC Sec. 1396m. Withholding of Federal share of payments for certain medicare providers
• 42 USC Sec. 1396n. Compliance with State plan and payment provisions
• 42 USC Sec. 1396o. Use of enrollment fees, premiums, deductions, cost sharing, and similar charges
• 42 USC Sec. 1396p. Liens, adjustments and recoveries, and transfers of assets
• 42 USC Sec. 1396q. Application of provisions of subchapter II relating to subpoenas
• 42 USC Sec. 1396r. Requirements for nursing facilities
• 42 USC Sec. 1396r-1. Presumptive eligibility for pregnant women
• 42 USC Sec. 1396r-2. Information concerning sanctions taken by State licensing authorities against health care practitioners and providers
• 42 USC Sec. 1396r-3. Correction and reduction plans for intermediate care facilities for mentally retarded
• 42 USC Sec. 1396r-4. Adjustment in payment for inpatient hospital services furnished by disproportionate share hospitals
• 42 USC Sec. 1396r-5. Treatment of income and resources for certain institutionalized spouses
• 42 USC Sec. 1396r-6. Extension of eligibility for medical assistance
• 42 USC Sec. 1396r-7. Assuring adequate payment levels for obstetrical and pediatric services
• 42 USC Sec. 1396r-8. Payment for covered outpatient drugs
• 42 USC Sec. 1396s. Program for distribution of pediatric vaccines
• 42 USC Sec. 1396t. Home and community care for functionally disabled elderly individuals
• 42 USC Sec. 1396u. Community supported living arrangements services
• 42 USC Sec. 1396v. References to laws directly affecting medicaid program
• 42 USC Sec. 2651. Recovery by United States
• 42 USC Sec. 2652. Regulations
• 42 USC Sec. 2653. Limitation or repeal of other provisions

• Medicare Program; Schedule of Limits on Home Health Agency Costs Per Visit for Cost Reporting Periods Beginning on or After July 1, 1997; Notice, [Federal Register: July 1, 1997 (Volume 62, Number 126)] [Notices] [Page 35607-35634].
• Medicare Program; Ambulance Services, [Federal Register: June 17, 1997 (Volume 62, Number 116)] [Proposed Rules] [Page 32715-32733]. This proposed rule would update and revise HCFA's policy on coverage of ambulance services. It would base Medicare coverage and payment for ambulance services on the level of medical services needed to treat the beneficiary's condition.
• Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1998 Rates; Proposed Rule, [Federal Register: June 2, 1997 (Volume 62, Number 105)] [Proposed Rules] [Page 29901-29951].
• Medicare Program; Medicare Appeals of Individual Claims, [Federal Register: May 12, 1997 (Volume 62, Number 91)] [Rules and Regulations] [Page 25844-25855]. This rule expands our regulations to recognize the right of Part B appellants to a hearing before an administrative law judge (ALJ) for claims if at least $500 remains in dispute and the right to judicial review of an adverse ALJ decision if at least $1,000 remains in controversy.
• Medicare Program; Establishment of an Expedited Review Process for Medicare Beneficiaries Enrolled in Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans, [Federal Register: April 30, 1997 (Volume 62, Number 83)] [Rules and Regulations] [Page 23368-23376]. This final rule with comment period establishes a new administrative review requirement for Medicare beneficiaries enrolled in health maintenance organizations (HMOs), competitive medical plans (CMPs), and health care prepayment plans (HCPPs).
• Medicare and Medicaid Programs; Salary Equivalency Guidelines for Physical Therapy, Respiratory Therapy, Speech Language Pathology, and Occupational Therapy Services, Federal Register: March 28, 1997 (Volume 62, Number 60)] [Proposed Rules] [Page 14851-14878].
• Medicare and Medicaid Programs: Use of the OASIS as Part of the Conditions of Participation for Home Health Agencies, [Federal Register: March 10, 1997 (Volume 62, Number 46)] [Proposed Rules] [Page 11035-11064]. Specifically, this proposed rule would require that HHAs use a standard core assessment data set, the ``Outcomes and Assessment Information Set'' (OASIS), when evaluating adult, non-maternity patients.
• Medicare and Medicaid Programs; Revision of Conditions of Participation for Home Health Agencies and Use of Outcome Assessment Information Set (OASIS); Proposed Rules, [Federal Register: March 10, 1997 (Volume 62, Number 46)] [Proposed Rules] [Page 11003-11005]. We are publishing two notices of proposed rulemaking relating to revised conditions of participation that home health agencies must meet to participate in the Medicare and Medicaid programs. This introduction explains the background for the two proposed rules and the interrelationship of the two documents.
• Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies, [Federal Register: March 10, 1997 (Volume 62, Number 46)] [Proposed Rules] [Page 11005-11035]. This proposed rule revises the existing conditions of participation that home health agencies must meet to participate in the Medicare program.
• Medicare and State Health Care Programs: Fraud and Abuse; Issuance of Advisory Opinions by the OIG, [Federal Register: February 19, 1997 (Volume 62, Number 33)] [Rules and Regulations] [Page 7350-7360]. In accordance with section 205 of the Health Insurance Portability and Accountability Act of 1996, this final rule establishes a new part 1008 in 42 CFR chapter V to address the new OIG advisory opinion process.
• Medicare Program; Electronic Cost Reporting for Skilled Nursing Facilities and Home Health Agencies, [Federal Register: January 2, 1997 (Volume 62, Number 1)] [Rules and Regulations] [Page 26-31].

• 42 CFR PART 405 - FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED SUBPARTS A AND B (RESERVED)
  • 42 CFR Sec. 405.502 Criteria for determining reasonable charges.
  • 42 CFR Sec. 405.702 Notice of initial determination.
  • 42 CFR Sec. 405.704 Actions which are initial determinations.
  • 42 CFR Sec. 405.1801 Introduction.
  • 42 CFR Sec. 405.2136 Condition: Governing body and management.
  • 42 CFR Sec. 405.2140 Condition: Physical environment.
• 42 CFR PART 406 - HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT SUBPART A - GENERAL PROVISIONS
  • 42 CFR Sec. 406.5 Basis of eligibility and entitlement.
  • 42 CFR Sec. 406.6 Application or enrollment for hospital insurance.
  • 42 CFR Sec. 406.11 Individual age 65 or over who is not eligible as a
  • 42 CFR Sec. 406.20 Basic requirements.
• 42 CFR PART 407 - SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND ENTITLEMENT
  • 42 CFR Sec. 407.1 Basis and scope.
  • 42 CFR Sec. 407.40 Enrollment under a State buy-in agreement.
  • 42 CFR Sec. 407.47 Beginning of coverage under a State buy-in agreement.
• 42 CFR PART 408 - PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE SUBPART A - GENERAL PROVISIONS
  • 42 CFR Sec. 408.1 Statutory basis.
  • 42 CFR Sec. 408.110 Collection of unpaid premiums.
• 42 CFR PART 409 - HOSPITAL INSURANCE BENEFITS SUBPART A - HOSPITAL INSURANCE BENEFITS: GENERAL PROVISIONS
  • 42 CFR Sec. 409.33 Examples of skilled nursing and rehabilitation
  • 42 CFR Sec. 409.40 Included services.
  • 42 CFR Sec. 409.42 Requirements and conditions for home health services.
  • 42 CFR Sec. 409.60 Benefit periods.
  • 42 CFR Sec. 409.61 General limitations on amount of benefits.
  • 42 CFR Sec. 409.87 Blood deductible.
  • 42 CFR Sec. 409.102 Amounts of payment.
• 42 CFR PART 410 - SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS SUBPART A - GENERAL PROVISIONS
  • 42 CFR Sec. 410.152 Amounts of payment.
  • 42 CFR Sec. 410.160 Part B annual deductible.
• 42 CFR PART 411 - EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT
  • 42 CFR Sec. 411.15 Particular services excluded from coverage.
  • 42 CFR Sec. 411.33 Amount of Medicare secondary payment.
  • 42 CFR Sec. 411.47 Apportionment of a lump-sum compromise settlement of a
  • 42 CFR Sec. 411.72 Medicare benefits secondary to employer group health
  • 42 CFR Sec. 411.408 Refunds of amounts collected for physician services
• 42 CFR PART 412 - PROSPECTIVE PAYMENT SYSTEM FOR INPATIENT HOSPITAL SERVICES
  • 42 CFR Sec. 412.2 Basis of payment.
  • 42 CFR Sec. 412.22 Excluded hospitals and hospital units: General rules.
  • 42 CFR Sec. 412.42 Limitations on charges to beneficiaries.
  • 42 CFR Sec. 412.62 Federal rates for fiscal year 1984.
  • 42 CFR Sec. 412.63 Federal rates for fiscal years after Federal fiscal
  • 42 CFR Sec. 412.71 Determination of base-year costs.
  • 42 CFR Sec. 412.96 Special treatment: Referral centers.
  • 42 CFR Sec. 412.106 Special treatment: Hospitals that serve a
  • 42 CFR Sec. 412.108 Special treatment: Medicare-dependent, small rural
  • 42 CFR Sec. 412.116 Method of payment.
• 42 CFR PART 413 PART 413 - PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES
  • 42 CFR Sec. 413.1 Introduction.
  • 42 CFR Sec. 413.5 Cost reimbursement: General.
  • 42 CFR Sec. 413.13 Amount of payment if customary charges for services
  • 42 CFR Sec. 413.24 Adequate cost data and cost finding.
  • 42 CFR Sec. 413.40 Ceiling on rate of hospital cost increases.
  • 42 CFR Sec. 413.64 Payments to providers: Specific rules.
  • 42 CFR Sec. 413.86 Direct graduate medical education payments.
  • 42 CFR Sec. 413.106 Reasonable cost of physical and other therapy services
  • 42 CFR Sec. 413.130 Introduction to capital-related costs.
  • 42 CFR Sec. 413.157 Return on equity capital of proprietary providers.
  • 42 CFR Sec. 413.170 Payments for covered outpatient maintenance dialysis
  • 42 CFR Sec. 413.174 Recordkeeping and cost reporting requirements for
• 42 CFR PART 416 - AMBULATORY SURGICAL SERVICES SUBPART A - GENERAL PROVISIONS AND DEFINITIONS Selected provisions follow.
  • 42 CFR Sec. 416.25 Basic requirements and procedures.
  • 42 CFR Sec. 416.30 Terms of agreement with HCFA.
  • 42 CFR Sec. 416.120 Payment for facility services.
• 42 CFR PART 417 - HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Selected provisions follow.
  • 42 CFR Sec. 417.401 Definitions.
  • 42 CFR Sec. 417.420 Basic rules on enrollment and entitlement.
  • 42 CFR Sec. 417.422 Eligibility to enroll in an organization.
  • 42 CFR Sec. 417.432 Conversion of enrollment.
  • 42 CFR Sec. 417.440 Entitlement to health care services from an
  • 42 CFR Sec. 417.442 Risk organizations: Conditions for provision of
  • 42 CFR Sec. 417.452 Liability of Medicare enrollees.
  • 42 CFR Sec. 417.460 Disenrollment of beneficiaries and termination of
  • 42 CFR Sec. 417.532 General considerations.
  • 42 CFR Sec. 417.536 Provider cost reimbursement principles applicable to
  • 42 CFR Sec. 417.546 Physicians' services and other Part B supplier
  • 42 CFR Sec. 417.548 Provider services through arrangements.
  • 42 CFR Sec. 417.576 Final settlement.
  • 42 CFR Sec. 417.592 Determination of required additional benefits.
  • 42 CFR Sec. 417.594 Computation of ACR.
  • 42 CFR Sec. 417.800 Reimbursement of health care prepayment plans;
  • 42 CFR Sec. 417.802 Allowable costs.
• 42 CFR PART 418 - HOSPICE CARE SUBPART A - GENERAL PROVISIONS AND DEFINITIONS Selected provisions follow.
  • 42 CFR Sec. 418.2 Scope of part.
  • 42 CFR Sec. 418.3 Definitions.
  • 42 CFR Sec. 418.56 Condition of participation - Professional management.
  • 42 CFR Sec. 418.202 Covered services.
  • 42 CFR Sec. 418.304 Payment for physician services.
• 42 CFR PART 420 - PROGRAM INTEGRITY: MEDICARE SUBPART A - GENERAL PROVISIONS Selected provisions follow.
  • 42 CFR Sec. 420.1 Scope and purpose.
  • 42 CFR Sec. 420.3 Other related regulations.
  • 42 CFR Sec. 420.201 Definitions.
  • 42 CFR Sec. 420.202 Determination of ownership or control percentages.
  • 42 CFR Sec. 420.203 Disclosure of hiring of intermediary's former
  • 42 CFR Sec. 420.204 Principals convicted of a program-related crime.
  • 42 CFR Sec. 420.205 Disclosure by providers of business transaction
  • 42 CFR Sec. 420.206 Disclosure of persons having ownership, financial, or
  • 42 CFR Sec. 420.300 Basis, purpose, and scope.
  • 42 CFR Sec. 420.301 Definitions.
  • 42 CFR Sec. 420.302 Requirement for access clause in contracts.
  • 42 CFR Sec. 420.303 HHS criteria for requesting books, documents, and
  • 42 CFR Sec. 420.304 Procedures for obtaining access to books, documents,
• 42 CFR PART 424 - CONDITIONS FOR MEDICARE PAYMENT SUBPART A - GENERAL PROVISIONS Selected provisions follow.
  • 42 CFR Sec. 424.1 Basis and scope.
  • 42 CFR Sec. 424.5 Basic conditions.
  • 42 CFR Sec. 424.22 Requirements for home health services.
  • 42 CFR Sec. 424.24 Requirements for medical and other health services
  • 42 CFR Sec. 424.52 Payment to a nonparticipating hospital.
  • 42 CFR Sec. 424.53 Payment to the beneficiary.
  • 42 CFR Sec. 424.56 Payment to a beneficiary and to a supplier.
  • 42 CFR Sec. 424.62 Payment after beneficiary's death: Bill has been paid.
  • 42 CFR Sec. 424.66 Payment to entities that provide coverage complementary
  • 42 CFR Sec. 424.354 Reclamation proceedings: Checks issued by carriers or
• 42 CFR PART 430 - GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS SUBPART A - INTRODUCTION; GENERAL PROVISIONS
  • 42 CFR Sec. 430.2 Other applicable Federal regulations.
  • 42 CFR Sec. 430.74 Issues at hearing.
• 42 CFR PART 431 - STATE ORGANIZATION AND GENERAL ADMINISTRATION
  • 42 CFR Sec. 431.54 Exceptions to certain State plan requirements.
  • 42 CFR Sec. 431.610 Relations with standard-setting and survey agencies.
  • 42 CFR Sec. 431.625 Coordination of Medicaid with Medicare part B.
  • 42 CFR Sec. 431.630 Coordination of Medicaid with PROs.
  • 42 CFR Sec. 431.701 Definitions.
  • 42 CFR Sec. 431.806 State plan requirements.
  • 42 CFR Sec. 431.812 Review Procedures
  • 42 CFR Sec. 431.814 Sampling plan and procedures.
• 42 CFR PART 433 - STATE FISCAL ADMINISTRATION
  • 42 CFR Sec. 433.15 Rates of FFP for administration.
  • 42 CFR Sec. 433.38 Interest charge on disallowed claims for FFP.
  • 42 CFR Sec. 433.112 FFP for design, development, installation or
  • 42 CFR Sec. 433.119 Conditions for reapproval; notice of decision.
  • 42 CFR Sec. 433.138 Determining liability of third parties.
  • 42 CFR Sec. 433.147 Cooperation in establishing paternity and obtaining
• 42 CFR PART 434 - CONTRACTS SUBPART A - GENERAL PROVISIONS Selected provisions follow.
  • 42 CFR Sec. 434.1 Basis and scope.
  • 42 CFR Sec. 434.2 Definitions.
  • 42 CFR Sec. 434.4 State plan requirement.
  • 42 CFR Sec. 434.6 General requirements for all contracts and subcontracts.
  • 42 CFR Sec. 434.10 Contracts with fiscal agents.
  • 42 CFR Sec. 434.12 Contracts with private nonmedical institutions.
  • 42 CFR Sec. 434.14 Contracts with health insuring organizations.
  • 42 CFR Sec. 434.20 Basic rules.
  • 42 CFR Sec. 434.70 Condition for FFP: Status of contract.
• 42 CFR PART 435 - ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA Selected provisions follow.
  • 42 CFR Sec. 435.3 Basis.
  • 42 CFR Sec. 435.121 Individuals in States using more restrictive
  • 42 CFR Sec. 435.301 General rules.
  • 42 CFR Sec. 435.308 Medically needy coverage of individuals under age 21.
  • 42 CFR Sec. 435.541 Determinations of disability.
  • 42 CFR Sec. 435.721 General requirements.
  • 42 CFR Sec. 435.725 Post-eligibility treatment of income and resources of
  • 42 CFR Sec. 435.726 Post-eligibility treatment of income and resources of
  • 42 CFR Sec. 435.733 Post-eligibility treatment of income and resources of
  • 42 CFR Sec. 435.735 Post-eligibility treatment of income and resources of
  • 42 CFR Sec. 435.945 General requirements.
  • 42 CFR Sec. 435.952 Use of information.
• 42 CFR PART 440 - SERVICES: GENERAL PROVISIONS SUBPART A - DEFINITIONS
  • 42 CFR Sec. 440.20 Outpatient hospital services and rural health clinic
  • 42 CFR Sec. 440.40 Skilled nursing facility services for individuals age
  • 42 CFR Sec. 440.70 Home health services.
  • 42 CFR Sec. 440.150 Intermediate care facility services, other than in
  • 42 CFR Sec. 440.200 Basis, purpose, and scope.
• 42 CFR PART 441 - SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES Selected provisions follow.
  • 42 CFR Sec. 441.310 Limits on Federal financial participation (FFP).
• 42 CFR PART 442 - STANDARDS FOR PAYMENT FOR SKILLED NURSING AND INTERMEDIATE CARE FACILITY SERVICES Selected provisions follow.
  • 42 CFR Sec. 442.12 Provider agreement: General requirements.
  • 42 CFR Sec. 442.113 Correction plans for ICFs/MR: Life Safety Code and
  • 42 CFR Sec. 442.114 Correction and reduction plans for ICFs/MR: General
  • 42 CFR Sec. 442.116 Reduction plans for ICFs/MR: Specific requirements.
• 42 CFR PART 447 - PAYMENTS FOR SERVICES SUBPART A - PAYMENTS: GENERAL PROVISIONS Selected provisions follow.
  • 42 CFR Sec. 447.10 Prohibition against reassignment of provider claims.
  • 42 CFR Sec. 447.20 Provider restrictions: State plan requirements.
  • 42 CFR Sec. 447.30 Withholding the Federal share of payments to Medicaid
  • 42 CFR Sec. 447.45 Timely claims payment.
  • 42 CFR Sec. 447.53 Applicability; specification; multiple charges.
  • 42 CFR Sec. 447.57 Restrictions on payments to providers.
  • 42 CFR Sec. 447.200 Basis and purpose.
  • 42 CFR Sec. 447.250 Basis and purpose.
  • 42 CFR Sec. 447.253 Other requirements.
  • 42 CFR Sec. 447.300 Basis and purpose.
  • 42 CFR Sec. 447.304 Adherence to upper limits; FFP.
  • 42 CFR Sec. 447.331 Drugs: Aggregate upper limits of payment.
  • 42 CFR Sec. 447.333 State plan requirements, findings and assurances.
  • 42 CFR Sec. 447.334 Upper limits for drugs furnished as part of services.
  • 42 CFR Sec. 447.371 Services furnished by rural health clinics.

• CR: Medicare
• CR: Fraud & Abuse
• Health policy (105th Congress)
• Medicare Bills (105th)
• Medicaid Bills (105th)

• Hillsborough County Hosp. Auth. v. Shalala (11th Cir. April 19, 1995) (denying Florida Hospitals' claims that they were entitled to an adjustment in their Medicare reimbursements based on the "extraordinary circumstances" exception of 42 U.S.C. §1395ww(b)(4)(A))
• New Jersey Hospital Association v. Waldman (2d Cir., December 29, 1995) (upholding district court's denial of injunction sought by NJHA against Medicaid reimbursement rates for general inpatient hospital services set by New Jersey Department of Human Services)
• Shalala v. Guernsey Memorial Hospital (U.S., March 6, 1995) (HHS Medicare regulations do not require reimbursement according to generally accepted accounting principles for validity)
• Thomas Jefferson University v. Shalala (U.S., June 24, 1994) (HHS interpretation of anti-redistribution principle, that Medicare should not pay for costs shifted from educational institutions to patient care institutions, was reasonable)

• Medicare: HCFA Faces Multiple Challenges to Prepare for the 21st Century. T-HEHS-98-85. 10 pp. plus 1 appendix (1 pp.) January 29, 1998. Discusses the Health Care Financing Administration's (HCFA) ability to meet growing program management challenges, focusing on: (1) HCFA's new authorities under recent Medicare legislation; (2) HCFA managers' views on the agency's capacity to carry out various Medicare-related functions; and (3) the actions HCFA needs to take to accomplish its objectives over the next several years.
• Department of Health and Human Services: Strategic Planning and Accountability Challenges. T-HEHS-98-96. 24 pp. February 26, 1998. Discusses the challenges the Department of Health and Human Services (HHS) faces in carrying out its mission effectively and cost-efficiently and in improving its accountability for the results of its efforts and its stewardship of taxpayer dollars.
• Medicare: HCFA Can Improve Methods for Revising Physician Practice Expense Payments. HEHS-98-79. February 27, 1998. GAO reviewed the Health Care Financing Administration's (HCFA) proposed practice expense revisions and its ongoing efforts to refine its data and methodologies.
• Medicaid: Sustainability of Low 1996 Spending Growth Is Uncertain (Letter Report, 06/27/97, GAO/HEHS-97-128). Pursuant to a congressional request, GAO reviewed Medicaid's spending growth rate
• Medicare: Need to Hold Home Health Agencies More Accountable for Inappropriate Billings (Letter Report, 06/13/97, GAO/HEHS-97-108). Pursuant to a congressional request, GAO reviewed Medicare's ability to detect and prevent inappropriate payments to home health agencies.
• Medicare Managed Care: HMO Rates, Other Factors Create Uneven Availability of Benefits (Testimony, 05/19/97, GAO/T-HEHS-97-133). GAO discussed aspects of Medicare managed care, including greater choice and equity across the program.
• Medicare Transaction System: Success Depends Upon Correcting Critical Managerial and Technical Weaknesses (Chapter Report, 05/16/97,GAO/AIMD-97-78). Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) acquisition of its Medicare Transaction System.
• Medicaid Managed Care: Challenge of Holding Plans Accountable Requires Greater State Effort (Letter Report, 05/16/97, GAO/HEHS-97-86). Pursuant to a congressional request, GAO reviewed state efforts to hold managed care plans accountable for meeting Medicaid program goals and for providing beneficiaries enrolled in capitated managed care plans the care they need.
• Medicare HMO Enrollment: Area Differences Affected by Factors Other Than Payment Rates (Letter Report, 05/02/97, GAO/HEHS-97-37). Pursuant to a congressional request, GAO reviewed the factors affecting Medicare risk health maintenance organization (HMO) enrollment.
• Medicare and Medicaid: Meeting Needs of Dual Eligibles Raises Difficult Cost and Care Issues (Testimony, 04/29/97, GAO/T-HEHS-97-119). Pursuant to a congressional request, GAO discussed several issues that arise in financing health care for people known as dual eligibles, Medicare beneficiaries who are also eligible for some form of Medicaid support.
• Medicare HMOs: HCFA Can Promptly Eliminate Hundreds of Millions in Excess Payments (Letter Report, 04/25/97, GAO/HEHS-97-16). Pursuant to a congressional request, GAO provided information on Medicare's rate-setting method for paying risk contract health maintenance organizations.
• Medicare Managed Care: HCFA Missing Opportunities to Provide Consumer Information (Testimony, 04/10/97, GAO/T-HEHS-97-109). GAO discussed: (1) Medicare beneficiaries' need for comparative information on health maintenance organizations (HMO); and (2) steps the Health Care Financing Administration (HCFA) could take to meet that need promptly.
• Medicare: Most Beneficiaries With Diabetes Do Not Receive Recommended Monitoring Services (Letter Report, 03/28/97, GAO/HEHS-97-48). Pursuant to a congressional request, GAO reviewed how well the health care system provides preventive services to Medicare beneficiaries with diabetes.
• Medicaid Fraud and Abuse: Stronger Action Needed to Remove Excluded Providers From Federal Health Programs (Letter Report, 03/31/97, GAO/HEHS-97-63). Pursuant to a congressional request, GAO reviewed the Department of Health and Human Services (HHS) Inspector General's (OIG) process for excluding providers from federal health care programs.
• Medicaid: Recent Spending Experience and the Administration's Proposed Program Reform (Testimony, 03/11/97, GAO/T-HEHS-97-94). GAO discussed recent Medicaid spending trends and their potential implications for future outlays.
• Medicare: Inherent Program Risks and Management Challenges Require Continued Federal Attention (Testimony, 03/04/97, GAO/T-HEHS-97-89). GAO discussed efforts to fight fraud and abuse in the Medicare program.
• Medicare Post-Acute Care: Home Health and Skilled Nursing Facility Cost Growth and Proposals for Prospective Payment (Testimony, 03/04/97, GAO/T-HEHS-97-90). GAO discussed Medicare's skilled nursing facility (SNF) and home health care benefits and the administration's forthcoming legislative proposals related to them.
• Medicaid: Decline in Spending Growth Due to a Combination of Factors (Testimony, 03/04/97, GAO/T-HEHS-97-91). GAO discussed recent Medicaid spending trends and their potential implications for future outlays.
• Medicare: Home Health Cost Growth and Administration's Proposal for Prospective Payment (Testimony, 03/05/97, GAO/T-HEHS-97-92). GAO discussed Medicare's home health care benefit and the administration's forthcoming legislative proposals related to this Medicare benefit.
• Medicare HMOs: Potential Effects of a Limited Enrollment Period Policy (Letter Report, 02/28/97, GAO/HEHS-97-50). Pursuant to a congressional request, GAO reviewed how a limited enrollment period would affect the Medicare program, private health plans, beneficiaries, and employers who provide Medicare supplemental benefits to retirees.
• Medicare: HCFA Should Release Data to Aid Consumers, Prompt Better HMO Performance (Chapter Report, 10/22/96, GAO/HEHS-97-23). Until recent years, nearly all Medicare beneficiaries received care through a fee-for-service arrangement, with benefits and cost-sharing provisions standardized nationwide.
• Medicare: Private-Sector and Federal Efforts to Assess Health Care Quality (Testimony, 09/19/96, GAO/T-HEHS-96-215). GAO discussed the Health Care Financing Administration's (HCFA) efforts to provide health care quality information to Medicare beneficiaries joining health maintenance organizations.
• Medicaid: Oversight of Institutions for the Mentally Retarded Should Be Strengthened (Letter Report, 09/06/96, GAO/HEHS-96-131). Pursuant to a congressional request, GAO reviewed the role of the Health Care Financing Administration (HCFA), state agencies, and the Department of Justice (DOJ) in overseeing quality of care in intermediate care facilities for the mentally retarded (ICF/MR).
• Medicaid Managed Care: Serving the Disabled Challenges State Programs (Chapter Report, 07/31/96, GAO/HEHS-96-136). Pursuant to a congressional request, GAO examined state efforts to include disabled Medicaid beneficiaries in prepaid managed care programs.
• Medicare: Private Payer Strategies Suggest Options to Reduce Rapid Spending Growth (Testimony, 04/30/96, GAO/T-HEHS-96-138). GAO discussed strategies to curb Medicare spending, which has grown by over 10 percent a year since 1989, twice the rate of the national economy.
• Medicare: Early Resolution of Overcharges for Therapy in Nursing Homes is Unlikely (Letter Report, 08/16/96, GAO/HEHS-96-145). Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) progress in curbing overbilling for occupational speech and physical therapy services.
• Medicaid: States' Efforts to Educate and Enroll Beneficiaries in Managed Care (Letter Report, 09/17/96, GAO/HEHS-96-184). Pursuant to a congressional request, GAO provided information on state efforts to enroll Medicaid beneficiaries in managed care.
• Fraud and Abuse: Providers Excluded From Medicaid Continue to Participate in Federal Health Programs (Testimony, 09/05/96, GAO/T-HEHS-96-205). GAO discussed whether the Department of Health and Human Services' (HHS) Office of Inspector General's (OIG) process for removing fraudulent health care providers from all federal health programs.
• Medicaid: Waiver Program for Developmentally Disabled Is Promising But Poses Some Risks (Letter Report, 07/22/96, GAO/HEHS-96-120). Pursuant to a congressional request, GAO reviewed states' experiences in utilizing the Medicaid waiver program to provide care for developmentally disabled adults in alternative settings.
• Medicare: Home Health Utilization Expands While Program Controls Deteriorate (Letter Report, 03/27/96, GAO/HEHS-96-16). Pursuant to a congressional request, GAO examined the growth in the use of Medicare home health benefits.
• Fraud and Abuse: Providers Target Medicare Patients in Nursing Facilities (Letter Report, 01/24/96, GAO/HEHS-96-18). Pursuant to a congressional request, GAO reviewed allegations of fraud and abuse related to services and supplies provided to nursing facility patients.
• Medicare: Federal Efforts to Enhance Patient Quality of Care (Chapter Report, 04/10/96, GAO/HEHS-96-20). Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) efforts to enhance the quality of care for Medicare beneficiaries.
• Medicare: Millions Can Be Saved by Screening Claims for Overused Services (Letter Report, 01/30/96, GAO/HEHS-96-49). GAO provided information on Medicare payments for unnecessary medical services.
• Medicare HMOs: Rapid Enrollment Growth Concentrated in Selected States (Letter Report, 01/18/96, GAO/HEHS-96-63). Pursuant to a congressional request, GAO provided information on the: (1) number of Medicare beneficiaries enrolling in health maintenance organizations (HMO); and (2) factors that influence beneficiaries' decisions to enroll in HMO.
• Medicare Managed Care: Growing Enrollment Adds Urgency to Fixing HMO Payment Problem (Letter Report, 11/08/95, GAO/HEHS-96-21). Pursuant to a congressional request, GAO reviewed Medicare payments to health maintenance organizations.
• Medicare: Enrollment Growth and Payment Practices for Kidney Dialysis Services (Letter Report, 11/22/95, GAO/HEHS-96-33). Pursuant to a congressional request, GAO reviewed Medicare's End Stage Renal Disease (ESRD) Program.
• Medicare Transaction System: Strengthened Management and Sound Development Approach Critical to Success (Testimony, 11/16/95, GAO/T-AIMD-96-12). GAO discussed the Health Care Financing Administration's (HCFA) approach to managing the Medicare Transaction System (MTS).
• Medicaid Section 1115 Waivers: Flexible Approach to Approving Demonstrations Could Increase Federal Costs (Chapter Report, 11/08/95, GAO/HEHS-96-44). Pursuant to a congressional request, GAO examined the financing arrangements for four approved section 1115 Medicaid demonstration waivers.
• Medicare Spending: Modern Management Strategies Needed to Curb Billions in Unnecessary Payments (Letter Report, 09/19/95, GAO/HEHS-95-210). Pursuant to a congressional request, GAO examined Medicare's vulnerability to provider exploitation and ways to remedy Medicare fraud and abuse.
• Medicaid: Tennessee's Program Broadens Coverage But Faces Uncertain Future (Letter Report, 09/01/95, GAO/HEHS-95-186). Pursuant to a congressional request, GAO reviewed Tennessee's Medicaid capitated managed care program (TennCare).
• Medicare: Increased HMO Oversight Could Improve Quality and Access to Care (Letter Report, 08/03/95, GAO/HEHS-95-155). The Congress is considering ways to attract Medicare beneficiaries to health maintenance organizations (HMO) and other forms of managed care in hopes of containing cost growth while preserving or improving quality and access to care.
• Medicare: Excessive Payments for Medical Supplies Continue Despite Improvements (Letter Report, 08/08/95, GAO/HEHS-95-171). In fiscal year 1994 alone, Medicare was billed over $6.8 billion for medical supplies.
• Medicare: Antifraud Technology Offers Significant Opportunity to Reduce Health Care Fraud (Letter Report, 08/11/95, GAO/AIMD-95-77). Pursuant to a congressional request, GAO provided information on how the Medicare program detects and prevents fraud.
• Health Insurance for Children: Many Remain Uninsured Despite Medicaid Expansion (Letter Report, 07/19/95, GAO/HEHS-95-175). Pursuant to a congressional request, GAO reviewed the status of health insurance for children.
• Medicare: Allegations Against ABC Home Health Care (Letter Report, 07/19/95, GAO/OSI-95-17). In response to a congressional request, GAO investigated allegations against ABC Home Health Care, a home health agency (HHA), and its participation in the Medicare home health care program.
• Medicaid: State Flexibility in Implementing Managed Care Programs Requires Appropriate Oversight (Testimony, 07/12/95, GAO/T-HEHS-95-206). Requiring states to obtain waivers to broaden use of managed care may hamper their efforts to aggressively pursue cost-containment strategies.
• Medicaid: Statewide Section 1115 Demonstrations' Impact on Eligibility, Service Delivery, and Program Cost (Testimony, 06/21/95, GAO/T-HEHS-95-182). The growth of Medicaid, which accounted for $142 billion in federal and state outlays in 1994, is outpacing even the growth of Medicare.
• Medicare Claims Billing Abuse: Commercial Software Could Save Hundreds of Millions Annually (Testimony, 05/05/95, GAO/T-AIMD-95-133). With an investment of only $20 million in off-the-shelf commercial software, Medicare could save nearly $4 billion over five years by detecting fraudulent claims by physicians--primarily manipulation of billing codes.
• Medicare Claims: Commercial Technology Could Save Billions (Letter Report, 05/05/95, GAO/AIMD-95-135). Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) potential use of commercial technology to detect Medicare billing errors.
• Medicaid Managed Care: More Competition and Oversight Would Improve California's Expansion Plan (Letter Report, 04/28/95, GAO/HEHS-95-87). Pursuant to a congressional request, GAO reviewed California's Medicaid managed care program, focusing on: (1) state oversight of managed care contractors; (2) state plans for expansion; and (3) key issues in implementing the expanded program.
• Medicaid: Restructuring Approaches Leave Many Questions (Letter Report, 04/04/95, GAO/HEHS-95-103). Pursuant to a congressional request, GAO provided information on various proposals for restructuring the Medicaid Program, focusing on the: (1) different restructuring approaches and their implications for federal-state financing and program administration; and (2) need to establish a reserve fund to offset state tax losses and increased enrollments.
• Medicaid: Spending Pressures Drive States Toward Program Reinvention (Chapter Report, 04/04/95, GAO/HEHS-95-122). The $131 billion Medicaid program is at a crossroads. Between 1985 and 1993, Medicaid costs tripled and the number of beneficiaries rose by more than 50 percent. Medicaid costs are projected to rise to $260 billion, according to the Congressional Budget Office.
• Medicare: Tighter Rules Needed to Curtail Overcharges for Therapy in Nursing Homes (Letter Report, 03/30/95, GAO/HEHS-95-23). Nursing homes and rehabilitation centers are taking advantage of ambiguous payment rules and lack of guidelines to bill Medicare at inflated rates for therapy services.
• Medicare Secondary Payer Program: Actions Needed to Realize Savings (Testimony, 02/23/95, GAO/T-HEHS-95-92). The Medicare secondary payer program ensures that other health and accident insurers pay medical costs for covered beneficiaries before Medicare kicks in.
• Medicare Part B: Regional Variation in Denial Rates for Medical Necessity (Letter Report, 12/19/94, GAO/PEMD-95-10). To determine whether Medicare carriers in various parts of the country differed significantly in denying coverage for medical treatment they consider unnecessary, GAO analyzed Medicare Part B data on claims processed by six Medicare carriers for 74 services that were either expensive or heavily used.
• Medicare: New Claims Processing System Benefits and Acquisition Risks (Letter Report, 01/25/94, GAO/HEHS/AIMD-94-79). A new system for processing Medicare claims offers considerable opportunities to improve Medicare operations and safeguard program dollars.
• Medicare: Graduate Medical Education Payment Policy Needs to Be Reexamined (Letter Report, 05/04/94, GAO/HEHS-94-33). It is widely held that the United States is not training enough primary care physicians relative to other types of physicians.
• Medicare: Greater Investment in Claims Review Would Save Millions (Letter Report, 03/02/94, GAO/HEHS-94-35). Given soaring U.S. health care costs and shrinking budgets for many government programs, Congress is concerned that Medicare pay only for appropriate medical services without compromising the quality of care provided to beneficiaries.
• Medicare: Inadequate Review of Claims Payments Limits Ability to Control Spending (Letter Report, 04/28/94, GAO/HEHS-94-42). Medicare overpayments of millions of dollars are being made because of inadequate safeguards by contractors who process Medicare claims and inattention by the federal Health Care Financing Administration
• Medigap Insurance: Insurers' Compliance With Federal Minimum Loss Ratio Standards, 1988-91 (Letter Report, 02/07/94, GAO/HEHS-94-47). From 1988 through 1991, the market for Medicare supplemental insurance--commonly called Medigap--grew by more than 50 percent; premiums rose from about $7 billion to $11 billion.
• Medicare and Medicaid: Many Eligible People Not Enrolled in Qualified Medicare Beneficiary Program (Letter Report, 01/20/94, GAO/HEHS-94-52). The Qualified Medicare Beneficiary Program pays many out-of-pocket expenses for Medicare recipients whose incomes are not quite low enough to qualify them for regular Medicare benefits.
• Medicare: Impact of OBRA-90's Dialysis Provisions on Providers and Beneficiaries (Letter Report, 04/25/94, GAO/HEHS-94-65). To control soaring Medicare costs, Congress has required that, in some cases, employer-sponsored group health plans covering Medicare beneficiaries pay medical claims before Medicare begins to foot the bill.
• Medicare: Shared System Conversion Led to Disruptions in Processing Maryland Claims (Letter Report, 05/23/94, GAO/HEHS-94-66). Since 1989, the Health Care Financing Administration (HCFA) has tried to reduce administrative costs by urging Medicare contractors to share claims processing system software and hardware with other contractors.
• Medicare: Changes to HMO Rate Setting Method Are Needed to Reduce Program Costs (Chapter Report, 09/02/94, GAO/HEHS-94-119). During the 1980s, the per capita costs of providing health care to the elderly under Medicare increased 59 percent, even after adjusting for inflation.
• Medicare: Beneficiary Liability for Certain Paramedic Services May Be Substantial (Briefing Report, 04/15/94, GAO/HEHS-94-122BR). Volunteer ambulance companies often transport Medicare patients to hospitals.
• Medicaid: States Use Illusory Approaches to Shift Program Costs to Federal Government (Letter Report, 08/01/94, GAO/HEHS-94-133). Medicaid, which provides health insurance for qualified low-income persons, is jointly funded by the federal government and the states.
• Medicare/Medicaid: Data Bank Unlikely to Increase Collections From Other Insurers (Letter Report, 05/06/94, GAO/HEHS-94-147). The Department of Health and Human Services has been directed to establish a data bank, beginning in February 1995, that would contain information on all workers, spouses, and dependents who are covered by employer-provided health insurance.
• Medicaid Prenatal Care: States Improve Access and Enhance Services, but Face New Challenges (Briefing Report, 05/10/94, GAO/HEHS-94-152BR). About 37,000 infants die in the United States each year, many unnecessarily.
• Medicaid Long-Term Care: Successful State Efforts to Expand Home Services While Limiting Costs (Letter Report, 08/11/94, GAO/HEHS-94-167). Because nearly one-third of the nation's Medicaid expenditures are now spent on long-term care ($42 billion in 1993), GAO was asked to review the experience of states in expanding government-funded home and community-based services.
• Medicare: HCFA's Contracting Authority for Processing Medicare Claims (Letter Report, 08/02/94, GAO/HEHS-94-171). Since 1966, the Health Care Financing Administration (HCFA) has awarded most contracts to process claims under Medicare parts A and B without competition, has renewed them annually, and has compensated contractors on a cost-reimbursement basis.
• Medicaid: Changes in Best Price for Outpatient Drugs Purchased by HMOs and Hospitals (Fact Sheet, 08/05/94, GAO/HEHS-94-194FS). Congress has tried to reduce Medicaid prescription drug costs by requiring drug manufacturers to give state Medicaid programs rebates for outpatient drugs.
• Medicare: Technology Assessment and Medical Coverage Decisions (Fact Sheet, 07/20/94, GAO/HEHS-94-195FS). Thousands of medical procedures, devices, and drugs are available for patient care in this country. Each year, public and private health care insurers make coverage decisions for these medical technologies.
• Medicare: Referrals to Physician-Owned Imaging Facilities Warrant HCFA's Scrutiny (Letter Report, 10/20/94, GAO/HEHS-95-2). Because Florida had the only statewide information then available on doctors with a financial stake in imaging center joint ventures, GAO analyzed 1990 Medicare claims for imaging services ordered by physicians in that state.
• Medicaid: HealthPASS: An Evaluation of a Managed Care Program for Certain Philadelphia Recipients (Chapter Report, 05/07/93, GAO/HRD-93-67). Federal and state policymakers believe that managed care programs are less expensive than traditional fee-for-service medical care, but critics express concern that cost-control measures may harm patient access to care and the quality of care.

• Medicaid Fraud and Abuse Information
• The Medicare Integrity Program Hmm...sounds important...might be worth checking out.
• Bipartisan Commission on Entitlement and Tax Reform: Interim Report America is at a fiscal crossroads - if we act, we can help ensure continued growth and prosperity, but if we fail to act, we threaten the financial future of our children and our Nation.
• HCFA Medicare Handbook Medicare is a federal health insurance program for people 65 or older and certain disabled people. It is run by the Health Care Financing Administration of the U.S. Department of Health and Human Services.
• HCFA Medicare Pamphlet Sooner or later, nearly everyone will be affected by Medicare, the Nation's major Federal health insurance program.
• HCFA's Research and Demonstration Initatives NEW AND PENDING Demonstration project proposals submitted pursuant to Section 1115(a) of the Social Security Act.
• HCFA: Medicaid Program Medicaid is a jointly-funded, Federal-State program which pays medical bills for approximately 36 million low-income and needy individuals.
• HCFA: Medicare Information A primary function of HCFA is the administration of Medicare. Medicare covers approximately 37 million Americans age 65 and over and those who have permanent kidney failure and certain people with disabilities.
• HCFA: Medicare Q&A, Part 1 The 85 most commonly asked questions about Medicare.
• HCFA: Medicare Q&A, Part 2 The 85 most commonly asked questions, continued.
• HCFA: Provider/Supplier Enrollment Initiative HCFA has recently undertaken a major initiative to identify and implement measures to prevent fraud and abuse in the Medicare program.
• Medicaid Reform Glossary Terms and definitions as they pertain to medicaid and medicaid reform.
• Medicare & Your Physician's Bill How Medicare pays for physician services and how Medicare determines how much it will pay.
• Medicare's 30th Anniversary On July 30, 1965, President Lyndon B. Johnson traveled to Independence, Missouri, and, in the presence of former President Harry Truman, signed Medicare into law.
• NewsHour Online: Medicare Transcripts of PBS broadcasts related to Medicare and Medicaid.

Administration on Aging Gopher ~ CHCR Homepage ~ Medicaid/Qualified Medicare Beneficiaries (QMB) ~ Medicare Page ~ Michigan Medicare/Medicaid Assistance Program ~ Protect Medicare and Medicaid ~ SSA Home Page ~ The Health Policy Page from IDEA CENTRAL ~ U.S. Medicaid Law ~ U.S. Medicare Law