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The Office of Inspector General (OIG) released a report that found that more than 3/4 of beneficiaries receiving home and community-based services in assisted living facilities did not meet the program’s requirements.
In 2009, 35 Medicaid programs reported that they used waivers to cover different home and community-based services for about 54,000 beneficiaries in assisted living facilities at an annual cost of $1.7 billion.
The violations included:
The OIG studied a group of patients in 7 states that have the highest numbers of people receiving these services. The states included Georgia, Illinois, Minnesota, New Jersey, Oregon, Texas and Washington.
Using claims data from these seven states, OIG officials looked more closely at the records of 150 beneficiaries selected in a random sample to determine whether the programs were meeting federal and state requirements.
The programs investigated by OIG officials covered services including homemaker services, personal care services and home health care.
CMS officials said they would issue guidance to state Medicaid officials urging them to make sure the facilities follow all of the rules of the waivers they received allowing states to treat beneficiaries in home and community-based settings.