The House of Representatives held a committee hearing on improper payments under the Medicaid program and part of the testimony included a Government Accountability Office report cited by thewritten testimonyof a witness. The following report from McKnight’s Senior Living offered some highlights (emphasis added)...
Assisted living made an appearance Thursday at a House of Representatives committee hearing on the Medicaid program when a Government Accountability Office report related to the industry was referenced in the written testimony of a witness.
Carolyn L. Yocom, a healthcare director at the GAO, focused her comments to members of the Committee on Oversight and Government Reform’s Government Operations and Intergovernmental Affairs subcommittees on opportunities to improve oversight of the Medicaid program as part of the hearing’s overall topic of improper payments in the program.
Improper payments across all federal programs have cost taxpayers an estimated $1.2 trillion since 2003, according to background information provided by the committee. The Department of Health and Human Services accounts for two-thirds of all federal improper payments, and the Medicaid program specifically contributes to approximately $36 billion of those improper payments, the committee said.
“Due to concerns about the adequacy of oversight, Medicaid has been on our list of high-risk programs since 2003,” Yocom said.
Three broad areas “critical” to improving Medicaid oversight, she added, include addressing data challenges, strengthening federal oversight, and improving and expanding federal and state collaboration.
These areas were evident in recommendations that the GAO made in January in a report titled “Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare is Needed.” In that report, the GAO recommended that the Centers for Medicare & Medicaid Services:
- Provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states using home- and community-based services waivers are required to report on their annual reports;
- 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; and
- Ensure that all states submit annual reports for HCBS waivers on time as required.
The report was one of several Yocom cited in an appendix in her written testimony. As of March, the recommendations had not been implemented, she wrote.
Some Takeaways and Notes:
Committee on Oversight and Government Reform’s Government Operations and Intergovernmental Affairs subcommittees
Improper Payments Within Medicaid
– over payments, fraudulent payments and underpayments
Encompasses the entire Fed government
1.3 Trillion in improper payments since Fiscal Year 2003.
2017 – 141 Billion improper payments
– 90 Billion Health & Human Services – 2/3 of all improper payments
– 36 Billion Medicaid
70 million Americans depend on Medicaid
Due to concerns about adequacy of oversight, Medicaid has been considered a high-risk program since 2003 according to Carolyn Yocom, healthcare director at the GAO.
Lack of comprehensive, national Medicaid database
Committee chairman Mark Meadows gave an example of fraudulent payments…
Case of a Virginia caregiver who participated in a scheme to defraud the Special Caregiver Program under Medicaid by submitting fraudulent time sheets for services not provided. In fact, the fraudster was in jail while operating the scheme. A simple check of the employees work status through a national database could have prevented the fraud. Numerous other examples are given in the presentation.
Addressing the issue…
Goal: improving Medicaid oversight, addressing data challenges, strengthening federal oversight as well as improving and expanding federal and state collaboration.
CMS should provide guidance and clarify requirements for states regarding monitoring & reporting of deficiencies and critical incidents in assisted living communities.
Having complete, accurate and timely data
- Better screening of payments
- Eliminate bad actors
- Reduce bureaucratic causes for improper payments
- Better data and more site visits (assisted living)
- Still need complete and accurate data on Medicaid (after 20 years, comprehensive, national Medicaid data project is still ongoing!)
CMS needs to provide guidance and clarify requirements for states regarding monitoring and reporting of deficiencies in assisted living communities.
Based on this hearing and the GAO’s report, broadscale changes for assisted living are not anticipated by stakeholders.
What various stakeholders and consumer groups are saying about the GAO’s work and potential reforms for assisted living reporting…
“The oversight of the assisted living industry at the state level has failed to protect residents,” – the Long Term Care Community Coalition and the Center for Medicare Advocacy
“Argentum is supportive of the GAO recommendations to ensure CMS has the information necessary for adequate oversight of Medicaid beneficiaries residing in assisted living communities. We look forward to working with the Senate, CMS and other stakeholders to implement these recommendations.” – Maribeth Bersani, Argentum Chief Operating Officer
“We support the GAO’s efforts to improve regulatory oversight between CMS and state Medicaid offices, and to step up information gathering efforts in order to ensure accountability.” – Steve Maag, LeadingAge Director of Residential Communities
“In some states, the monitoring system and the critical incident management reporting system meet CMS requirements, and I actually wouldn’t anticipate any changes. The state may already have robust monitoring processes in place … The recommendations have much stronger implications for the Medicaid state offices than for assisted living providers directly, because the recommendations are all aimed squarely at the guidance that CMS needs to be issuing to states — what data the states should be collecting and then reporting back to CMS. So the evaluation and the findings really focus on the CMS oversight process and the reporting process. At this point, I’m not anticipating, just looking at these findings, broadscale changes for assisted living. – ”Lilly Hummel, JD, MPA, senior director of policy and program integrity, National Center for Assisted Living
…Normalizing the reporting and publishing of facility deficiencies would certainly be a great first step to benefit consumers that is long overdue.” – Brian Lee, executive director of Families for Better Care
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