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 GAO Report Examines CMS Oversight of Assisted Living Facilities

A Government Accountability Office (GAO) report released on Feb. 5 said the states and Centers for Medicare & Medicaid Services (CMS) must bolster their oversight of Medicaid home- and community-based services (HCBS) in the assisted living setting.

The report, “Medicaid Assisted Living Services: Improved Oversight of Beneficiary Health and Welfare Is Needed,” explains how states and CMS oversee HCBS waiver programs, specifically for coverage of services in assisted living. The findings call for better state reporting of critical incidents, with more guidance and enforcement needed from CMS on exactly what information states must report.

Specifically, GAO offered three recommendations. The first is that the administrator of 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.”

The second said the CMS administrator should implement 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.”

Lastly, GAO wants CMS to make sure states submit annual reports for HCBS waivers on time as required by stated deadlines.

In reaction to the GAO report, National Center for Assisted Living (NCAL) Executive Director Scott Tittle said NCAL “appreciates the diligent work of GAO to help Congress better understand Medicaid in assisted living. All Medicaid recipients deserve the utmost care, and the vast majority of assisted living providers who participate in the program are providing it.”

He said that NCAL concurs with GAO on the need for safeguards to ensure high-quality care, and when combined with better data from the states, it will allow for a better understanding of Medicaid’s impact on assisted living residents.



“NCAL and our state affiliates stand 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 provided in assisted living communities,” Tittle said.


The GAO report is at: www.gao.gov/products/GAO-18-179.

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