GAO Report Finds Inadequate Oversight of Medicaid Waivers; Senator Calls For Immediate Plan of Correction

On June 20, 2003, The U.S. General Accounting Office (GAO) issued a report finding a systemic failure of the Federal government to ensure quality, safe services for individuals receiving supports under home and community based Medicaid waiver programs  The findings in this report will come as no surprise to the many P&As who, over the years, have sought improvement from the Centers for Medicare and Medicaid Services, for the very problems the GAO report identifies. Now that this report has gotten the attention of federal lawmakers, the time is ripe for P&As to renew our push for improved federal oversight.

In brief, the GAO finds that CMS has not developed detailed state guidance on appropriate quality

Assurance; CMS does not adequately monitor state waivers and the quality of beneficiary care; CMS does not hold their regional offices accountable for completing periodic waiver reviews, nor does it hold states accountable for submitting annual reports on the status of waiver quality; the data on quality of care is poor, but even what little data there is shows significany problemsd in the quality of care received by waiver participants, such as failure to provide necessary supports, insufficient plans of care, and lack of case management. To address these problems the GAO recommends that the Administrator of CMS take steps to, better ensure that state quality assurance efforts are  adequate to protect the health and welfare of HCBS waiver beneficiaries, and strengthen federal oversight of the HCBS waiver programs. Although CMS raised certain concerns about aspects of the report, such as the respective state and federal roles in quality assurance and the potential need for additional federal oversight resources, CMS generally concurred with the recommendations.

In response to the report, Senator Grassley has written a letter to the Secretary of the Department of Health and Human Services expressing concern about the findings and requesting that by the end of this month HHS send him “a detailed plan, including implementation dates, of how the oversight weaknesses identified in this report will be addressed.”   The report can be downloaded from www.gao.gov.  When you get to that page do a search for the report by date "June 20" and report number "GAO-03-576."