GAO Report Calls for Increased CMS Oversight of Medicaid Services in Assisted Living Facilities

The Government Accountability Office (GAO) recently released a report entitled “Medicaid Assisted Living Services: Improved Oversight of Beneficiary Health and Welfare is Needed.” The report, released on February 5, 2018, examines the current oversight by the Centers for Medicare & Medicaid Services (CMS) of Medicaid covered services in assisted living facilities. The report suggests that CMS, in cooperation with state Medicaid agencies, must increase its oversight of such Medicaid services.

The report reviews state spending and coverage of Home and Community Based Services (HCBS) Medicaid waiver programs for services in the assisted living setting, describes current state oversight of the health and welfare of beneficiaries, and examines current CMS oversight of state Medicaid agencies in monitoring such services. The report notes that “State Medicaid agencies in 48 states that covered assisted living services reported spending more than $10 billion (federal and state) on assisted living services in 2014. These 48 states reported covering these services for more than 330,000 beneficiaries through more than 130 different programs.” Most of these programs are Medicaid waivers. GAO found varied approaches in how states monitor and report critical incidents involving Medicaid beneficiaries receiving assisted living services. The report notes that there are wide gaps and inconsistencies in the monitoring and reporting of critical incidents.

GAO notes that “[i]n recent years, CMS has taken steps to improve oversight of beneficiary health and welfare in HCBS programs by adding new HCBS waiver application requirements for state monitoring of beneficiary health and welfare,” but according to CMS officials, the states have wide discretion over information gathering and reporting.

The GAO report findings emphasize the need for improved state reporting of incidents along with related guidance from CMS. The report includes the following three recommendations for CMS:

• Recommendation 1: CMS should provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states using HCBS waivers are required to report on their annual reports.
• Recommendation 2: CMS should establish standard Medicaid reporting requirements for all states to annually report key information on critical incidents, considering, at a minimum, the type of critical incidents involving Medicaid beneficiaries, and the type of residential facilities, including assisted living facilities, where critical incidents occurred.
• Recommendation 3: CMS should ensure that all states submit annual reports for HCBS waivers on time as required.

The Department of Health and Human Services (HHS) provided comments to GAO’s draft report, which are included in the final report. HHS concurred with Recommendations 1 and 3. HHS did not explicitly comment on Recommendation 2. HHS has established a workgroup through 2018 to address potential additional reporting requirements.

To access the full GAO report, please click here.