Report to Congress: High Volume and High Payment Procedures in the Medicaid Population

摘要

Under section 9432(b) of the Omnibus Budget Reconciliation Act of 1986, Congress mandated that the Secretary of the Department of Health and Human Services provide information pertaining to second surgical opinion and preadmission review programs in the Medicaid program. The mandate can be broken down into three basic topics. First, it requires information such as payment rates, aggregate payments, and rates of performance for high volume and high cost surgical procedures in the Medicaid population. The second request was for information on the extent to which second surgical opinion or preadmission review programs may impede access to necessary care and the measures States have taken to address such impediments. Third, the mandate states that the Secretary should identify surgical procedures that may be appropriate for a mandatory second surgical opinion program under Medicaid, considering factors about the procedures such as potential risk, volume, cost, nonconfirmation rates, and geographic variation. The report responds to the congressional mandate.