- Washington Guardian - Tuesday, December 11, 2012

A $1.7 billion initiative by state and local governments to allow Medicare seniors to live more independently is actually sending large numbers of patients to assisted living facilities with licensing or other problems, a federal watchdog warns.

The Department of Health and Human Services’ inspector general on Tuesday urged federal government to provide greater oversight to the Home and Community Based Services (HCBS) programs after a review in seven states found nearly 77 percent of the patients received the care through facilities that had problems with licensing and certification.

“Each state had federally mandated provider standards; however, [facilities] in the seven selected states did not always comply with them, and federally required plans of care did not always meet federal requirements,” the IG’s report said.

The HCBS programs are designed to help seniors at assisted living facilities with services ranging from case management and nursing assistance to personnel to help with cleaning and cooking.  


And there has been increased demand by seniors for HCBS.  According to Tuesday’s IG report, between 2002 and 2009, the number of program beneficiaries has grown by 122 percent. States are supposed to determine whether their Medicare programs will help cover the costs.

Currently, 35 states cover HCBS, and the inspector general found widespread problems in the seven states with the highest number of beneficiaries. Among the problems cited in the report:

  • 77 percent of beneficiaries received HCBS at facilities cited for a deficiency involving noncompliance with at least one state licensure or certification requirement.
  • 9 percent of beneficiaries’ records did not include plans of care required by the states.
  • 42 percent of the federally required plans of care did not include the frequency of HCBS furnished, as required.
  • Five of the seven states also required that plans of care specify the beneficiaries’ goals and the interventions to meet them. But 69 of the 105 plans of care for beneficiaries in those states did not meet that requirement

The internal watchdog said that the Centers for Medicare and Medicaid Services should issue guidelines to state Medicare agencies to ensure all facilities that provide HCBS are meeting government requirements.  

CMS agreed, and said it would help states try to understand what is required when caring for seniors.

“We will review our guidelines to determine whether additional clarity is needed, and whether we can offer some technical assistance to states in how to meet the present requirements,” CMS wrote in a letter included in the report.

The investigation is the latest to uncover problems inside the massive Medicare program highlighted by the Washington Guardian that have ranged from sensitive data breaches to wasteful spending on skilled nursing facilities.