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OIG Report: Assisted Living Facilities Not Complying With All Medicaid HCBS Requirements

by Published On: Dec 11, 2012

More than 3/4 of beneficiaries receiving home and community-based services in assisted living facilities did not meet the program’s requirements, according to an Office of Inspector General (OIG) report.  

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: 

  • 9% of beneficiaries’ records did not include the plans of care that states require, and many plans of care did not include important information, such as the frequency of services provided. 
  • 5 of the 7 states also required that plans of care specify the beneficiaries’ goals and the interventions, yet  69 of 105 plans of care did not include that information. 

  • 2 of the 7 states also said beneficiaries should sign their plans of care, but almost half of the plans of care did not meet that requirement. 
  • State officials failed to ensure that facility staff had the required education and training to provide such services and failing to ensure that medication was dispensed by certified staff.

The OIG studied a group of patients in 7 states that have the highest numbers of people receiving these services:

  • Georgia.
  • Illinois.
  • Minnesota.
  • New Jersey.
  • Oregon.
  • Texas.
  • 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.


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