Puerto Rico: efforts to improve competition for Medicaid procurement : testimony before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives
- Collection:
- Health Policy and Services Research
- Contributor(s):
- United States. Government Accountability Office. issuing body. United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health. issuing body.
- Publication:
- Washington, DC : United States Government Accountability Office, March 17, 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Economic Competition -- legislation & jurisprudence Fraud -- prevention & control Government Regulation Medicaid -- economics Puerto Rico United States Centers for Medicare & Medicaid Services (U.S.)
- Genre(s):
- Technical Report
- Abstract:
- Notable differences exist in the funding and operation of Puerto Rico’s Medicaid program as compared with the states. Similar to states, the federal government and Puerto Rico jointly fund Medicaid to provide health care coverage for low-income and medically needy populations. However, federal law has historically established the federal matching rate for Medicaid expenditures in Puerto Rico at the lowest rate available to states, while matching rates for the states are determined each year based on a formula that takes into account variations in their per capita incomes. In addition, unlike states that receive open-ended federal matching funds, Puerto Rico can access federal funds for Medicaid up to an annual limit. Roughly 40 percent of Puerto Rico’s population qualifies for Medicaid, and over the past decade, Congress has provided Puerto Rico with increased federal Medicaid funding. Similarly, as is the case with states, Puerto Rico’s Medicaid program is required to cover certain benefits—known as mandatory Medicaid benefits. However, CMS has not always enforced this program requirement in Puerto Rico. For example, in April 2016, we found that Puerto Rico did not cover seven of the 17 mandatory Medicaid benefits, including nursing facility services and home health services. With respect to Medicaid procurement, HHS regulations apply to both states and Puerto Rico. Specifically, HHS regulations generally require a state or territory to “follow the same policies and procedures it uses for procurements from its non-federal funds.” In addition, under HHS regulations, the agency may require a state or territory to comply with federal competition standards that apply to other non-federal entities under limited circumstances, such as when the agency determines that the state’s or territory’s procurement process for certain procurements is an impediment to competition that could substantially impact project cost or the risk of failure.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (6 pages))
- NLM Unique ID:
- 9918317782006676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918317782006676