Assisted living providers who serve Medicaid beneficiaries will be the focus of a report released by the Department of Health and Human Services Office of Inspector General between Oct. 1, 2019, and Sept. 30, 2020, the office said Thursday in releasing updates to its work plan.
The timing aligns with the federal 2020 fiscal year.
“We will determine whether assisted living providers are meeting quality-of-care requirements for Medicaid beneficiaries residing in assisted living facilities and whether the providers properly claimed Medicaid reimbursement for services in accordance with Federal and State requirements,” the OIG said.
The office’s effort will follow up on a 2018 report by the Government Accountability Office that “indicated that improved Federal oversight of beneficiary health and welfare is needed in States’ administration of Medicaid assisted living services,” the announcement said. In April, the GAO said that one of three recommendations made to the Centers for Medicare & Medicaid Services in that report remained unaddressed, and the GAO urged CMS to take action.
The OIG previously had announced that it also will release in fiscal year 2020 a report on personal care services that help Medicaid beneficiaries with activities of daily living.
“Prior OIG reviews identified significant problems with States’ compliance with PCS requirements. Some reviews also showed that program safeguards intended to ensure medical necessity, patient safety, and quality, and prevent improper payments were often ineffective,” the office said in April. “We will determine whether improvements have been made to the oversight and monitoring of PCS and whether those improvements have reduced the number of PCS claims not in compliance with Federal and State requirements.”