CMS should improve oversight of HCBS, GAO says

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CMS should improve oversight of HCBS, GAO says
CMS should improve oversight of HCBS, GAO says

The Centers for Medicare & Medicaid Services should standardize federal requirements for programs providing personal care services for Medicaid beneficiaries, including residents of assisted living communities, to protect beneficiaries from care-related harm and ensure that billed services are provided, the Government Accountability Office said in a new report publicly released Dec. 22.

Additionally, the report authors recommended, CMS should collect and analyze required state reports on services that assist Medicaid beneficiaries with activities of daily living to obtain insights into the programs' effects on beneficiaries' health and welfare.

The GAO made its suggestions after reviewing practices in four states — California, Maryland, Oregon and Texas — examining laws and other information, and interviewing CMS officials. The agency conducted the research at the request of the Senate Homeland Security and Governmental Affairs Committee and the House of Representatives' Energy and Commerce Committee.

The final rule issued by CMS in 2014 that establishes new requirements for what constitutes a home- and community-based setting will help standardize federal requirements across the different types of PCS programs, according to the report, but states implementing HCBS Waiver or State Plan HCBS programs still are required to submit more information related to beneficiary safety and billing than are states implementing State Plan PCS or Community First Choice programs.

“A more consistent administration of policies and procedures across programs could help the federal government and states better manage risks to beneficiaries and protect the integrity of the program,” the report authors said.

The GAO said that the Department of Health and Human Services has concurred with its recommendations.

Spending on long-term care services and supports represents approximately 25% of Medicaid expenses annually and is expected to increase, the GAO said.

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