The Medicaid program needs better data to be able to ensure that it does not overpay for personal care services and to reduce the risk of fraud occurring, the Government Accountability Office said in a January report made public on Monday.
Medicaid spent approximately $80 billion to provide assistance with activities of daily living in home- and community-based settings such as assisted living communities in 2014, the report noted. The amount exceeds spending on institutional long-term care, according to the GAO, and is expected to increase along with the demand for such services.
The Centers for Medicare & Medicaid Services manages two data systems that collect information from states on the provision of and spending on personal care services for Medicaid beneficiaries, the report noted. The ability of CMS to use these data for oversight purposes is limited, however, because the data are old, incomplete or incorrectly reported, missing key information or lacking comparable information, the GAO said.
The report noted that CMS is developing a new Medicaid claims system to replace one of its systems, the Medicaid Statistical Information System, and recently had established a new office to support the agency’s use of Medicaid data for program management and monitoring. “However, CMS has not issued guidance related to reporting of personal care services that addresses the gaps GAO identified or developed plans to use the data for oversight purposes,” the report said. “Without improved data and plans for how it can be used for oversight, CMS could continue to lack critical information on personal care service expenditures.”
The U.S. Department of Health and Human Services, of which CMS is a part, agreed with two of the GAO’s recommendations to obtain better data, according to the report — that CMS ensure that states comply with reporting requirements and develop plans to use data to oversee the provision of and payment for personal care services.
HHS, the GAO added, neither agreed nor disagreed with two other recommendations — that CMS develop standardized guidance for the reporting of key data by states and ensure that data on the provision of services link with data on reported expenditures.
