GAO Report on Oversight of Medicaid-Covered Services in Assisted Living Communities

Lilly Hummel

This week the Government Accountability Office (GAO) released a report on Medicaid in assisted living, entitled “Medicaid Assisted Living Services: Improved Oversight of Beneficiary Health and Welfare Is Needed.” Generally the report calls for better state reporting of critical incidents, with more guidance and enforcement needed from the Centers for Medicaid and Medicare Services (CMS) on exactly what information states must report. It does not call for federal regulation of assisted living.

NCAL stands ready to work with policymakers at the national and local levels on strategies that strengthen the gathering of information on home and community-based services, including those in provided in assisted living communities. Appropriate safeguards are necessary to ensure high quality care, and that with better data, we can better understand Medicaid’s impact.

The report explains how states and CMS oversee home and community-based services (HCBS) waiver programs, specifically for coverage of services in assisted living communities. It also provides descriptive statistics on the state-reported number of Medicaid beneficiaries receiving services in AL and Medicaid spending on these beneficiaries.

GAO’s findings acknowledged CMS’ progress to improve oversight of health and welfare of beneficiaries receiving services covered by an HCBS waiver, but concluded that more needs to be done. The agency made three recommendations to CMS:

1. 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.
2. 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.
3. Ensure that all states submit annual reports for HCBS waivers on time as required.

NCAL will be meeting with the offices of the four senators who requested the work—Senators Collins, McCaskill, Hatch, and Warren—as well as CMS to discuss next steps.