Data on Medicaid-funded personal care services need to be improved, GAO says

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One of 79 new actions that Congress or executive branch agencies could take to improve operations across government, according to the Government Accountability Office's seventh annual report, released Wednesday, involves personal care services funded by Medicaid.

“The Centers for Medicare & Medicaid Services needs timely, complete, and consistent data on Medicaid personal care services so it can effectively monitor these services, which could lead to tens of millions of dollars in annual savings,” the GAO stated.

Total expenditures for personal care services — professional assistance with activities of daily living — were almost $15 billion in fee-for-service expenditures in 2015, an increase of $2.3 billion from 2012, according to CMS data systems cited in the GAO report. The data in these systems, however, may not be complete, according to the GAO.

Also, the office noted, CMS has indicated that more than $2 billion in 2014 payments for personal care services, or 6%, were improper. That rate is the third-highest rate among all Medicaid service categories, the GAO said.

“We recommend that CMS establish standard reporting guidance for personal care service claims to ensure that key data reported by states, such as provider identification numbers and the type, quantity, and dates of services, are complete and consistent,” the report authors recommended.

Personal care services also have been the focus of additional GAO reports. See the links under “Related Articles,” below, for additional information.

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