Wednesday, February 15, 2017

GAO Releases Two Reports on Medicaid Long-Term Services and Supports

Lilly Hummel
Both reports signal continued interest in strengthening Centers for Medicare and Medicaid Services (CMS) and state oversight of home and community-based services, particularly for personal care services.

 In a recent report, GAO reviewed CMS data collection on services provided in home and community-based settings. GAO found that CMS’ data were limited because of data gaps and errors. Although the agency is developing a new Medicaid claims system and established a new office to support its use of Medicaid data for program management and monitoring, CMS still has not improved data collection or plans for how to use the data for oversight purposes. GAO recommended that CMS improve personal care services data by: establishing standard reporting guidance for key data; ensuring linkage between data on the provision of services and reported expenditures; ensuring state compliance with reporting requirements; and developing plans to use data for oversight.

In a second report issued last month, GAO studied oversight of an increasing number Medicaid managed long term services and supports (MLTSS) programs, which can include services provided in assisted living. However, according to GAO, whether these programs are an effective strategy depends, in part, on the design of the payment structures. GAO recommended that CMS: require all states to report on progress toward achieving MLTSS program goals; establish criteria for what situations would warrant exceptions to federal standards for data used to set rates; and provide guidance with minimum standards for validating encounter data.

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