A federal government report released Friday devotes only three sentences in its 118 pages to a step the Centers for Medicare & Medicaid Services is taking to address issues raised in the Government Accountability Office’s early 2018 report on federal oversight of assisted living communities.
The Health and Welfare Special Review Teams project referred to in the “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2018” from the Department of Health and Human Services and the Department of Justice, however, could have lasting effects on assisted living communities that accept federal dollars.
That early 2018 GAO report, you’ll recall, contained a to-do list for CMS related to state reporting of deficiencies in care and services provided to Medicaid beneficiaries residing in assisted living communities. That to-do list came after the report found that more than $10 million in federal and state funds were spent to cover assisted living services for more than 330,000 Medicaid beneficiaries in 48 states in 2014, yet 26 of the 48 state Medicaid agencies studied could not report the number of “critical incidents” — such as abuse, neglect or exploitation — that occurred in the assisted living communities located in their states.
The H&W SRT project, the new HHS / DOJ report pointed out, began in September “to ensure that state quality monitoring methodologies are efficiently and effectively preventing, detecting, and remediating all instances of abuse and/or neglect to beneficiaries in home and community based settings including group homes, and assisted living programs.”
The teams, according to the new report, “will develop an overall strategy for identifying, preventing, and addressing any systemic problems in the states’ implementation of and compliance with health & safety oversight systems within these settings.”
In an April webinar, CMS described the teams as “a key tool for CMS and states to improve the health and welfare of HCBS participants,” including group home and assisted living residents, as a response to the 2018 GAO report and other government findings.
As the author of the GAO report told me, the GAO report was “new territory” because the federal government had not looked at assisted living oversight from the same standpoint before. So for that reason alone, the new H&W SRT project could be thought of as a big effort.
According to CMS, the teams will spend three years conducting site visits, collecting best practices and providing assistance to CMS and state Medicaid programs to address issues. CMS and the teams also will develop training and education materials covering topics such as risk assessment and mitigation as well as balancing individual choice and safety.
If a state Medicaid program has one or more HCBS programs due for renewal soon, requests technical assistance, has challenges in monitoring beneficiary health and welfare, or has one or more promising practices to offer, then it will be prioritized for technical assistance.
In future years, assisted living may receive more than three sentences of attention in the HHS / DOJ annual report about fraud and abuse control. For all the right reasons, we hope.