CMS Administrator Seema Verma

The Centers for Medicare & Medicaid Services said it will step up its work with states to ensure that adult foster care homes and other home- and community-based settings meet health, safety and administrative requirements after a review by the Health and Human Services Office of Inspector General found compliance lacking.

The OIG released its report Tuesday.

The office reviewed 20 adult foster care homes in Minnesota with residents who are Medicaid beneficiaries and receive home- and community-based services under Section 1915(c) waivers. Such homes are licensed to provide food, lodging, supervision and household services and also may provide personal care and medication assistance.

Knives left out in the open. (HHS OIG)

The OIG found 39 health and safety violations and 25 administrative violations at 18 of the homes. For instance, knives were left out in the open at a residence where an adult had “either a physical aggression towards others or had a medical condition (i.e., dementia),” the report said.

And in another instance, several carbon dioxide-powered handguns were found outside of an adult’s bedroom door, according to the report.

Guns left out in the open. (HHS OIG)

Additionally, the OIG said, Minnesota did not ensure that all adult foster care homes completed abuse-prevention plans.

State officials attributed noncompliance to low staffing levels that limited their oversight and monitoring abilities, insufficient training about state requirements, the absence of templates for state-required administrative records, and unclear state requirements.

In a March 28 letter included in the report, CMS Administrator Seema Verma said her agency concurred with the OIG’s recommendations to work with states to ensure that issues of noncompliance were corrected. CMS, she noted, can issue a moratorium on waiver enrollment or withhold federal payments until states comply.

Verma also said the agency would provide technical assistance to states regarding staffing models, state-provided training to homes and, possibly, templates that could be used for administrative records. CMS will be conducting a national survey about incident-management systems for home- and community-based services and will share best practices for identifying, collecting and reporting incidents, she added.

The report’s recommendations also cover compliance issues at 80 adult day centers across Illinois, Minnesota, Mississippi and Wisconsin.