Dive Brief:
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The Government Accountability Office reported issues with state oversight of assisted living facilities in a review of state Medicaid programs, including that 26 state agencies couldn’t report the number of critical incidents that occurred in their facilities. Nine of those states said they weren't able to track incidents by provider type, another nine states blamed the lack of a system to collect those incidents and five others said they didn’t have a system to identify Medicaid beneficiaries.
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The report by the congressional watchdog recommends CMS demand better oversight and clarify state requirements for reporting program deficiencies and require annual reporting of critical incidents. HHS supported GAO’s suggestions.
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The GAO said states don't agree on what are considered deficiencies affecting beneficiary health and welfare.
Dive Insight:
CMS and state Medicaid programs share responsibility to ensure that beneficiaries’ health and welfare are protected in assisted living facilities, GAO noted.
But there’s a disconnect between CMS and states because there isn’t “clear guidance on reportable deficiencies and no requirement to report critical incidents.” This can lead to both the federal and state level agencies being unaware of problems with assisted living facilities.
The investigation came after a bipartisan group of senators in 2015 requested a look into the oversight and quality of care provided Medicaid beneficiaries in assisted living facilities.
In a review from March 2016 to January 2018, the GAO examined state and federal oversight of the services. They looked into the 48 state Medicaid agencies that spent about $10 billion for assisted living services in 2014.
The GAO also found issues with how states report critical incidents. All states consider physical, emotional or sexual abuse as a critical incident, but some states did not identify other problems. For instance, seven states didn’t indicate potential harm or neglect, such as medication errors, as a critical incident. Three states didn’t consider unexplained death as a critical incident.
After the GAO’s report, senators who requested the report spoke out about the findings and the need for better oversight after the “troubling findings.” Sen. Elizabeth Warren (D-Mass.) said the federal government needs to “make sure we have the information necessary to ensure accountability.” Warren added that she plans to file legislation to address issues found in the report.