Medicaid Waiver HCBS: OIG Makes Recommendations on Quality

Members | June 21, 2012 | by Peter Notarstefano

The Office of the Investigator General (OIG) released “Oversight of Quality of Care in Medicaid Home and Community Based Services Waiver Programs” (OEI-02-08-00170), a report that recommends a number of changes to improve Medicaid HCBS Waiver services. 

The Office of the Investigator General (OIG) released Oversight of Quality of Care in Medicaid Home and Community Based Services (HCBS) Waiver Programs (OEI-02-08-00170).

To operate their HCBS waiver programs, states must meet 3 assurances. States must demonstrate that they have systems to effectively monitor

  1. The adequacy of service plans.
  2. The qualifications of providers.
  3. The health and welfare of beneficiaries. We based this study on a review of documents from CMS's most recent quality review of waiver programs from 25 states, as well as information gathered from structured interviews with staff from the 10 CMS regional offices.

Seven of the 25 states that the OIG reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries, even though CMS had renewed the waiver programs in all 7 of these states. 

Three states did not adequately correct identified problems.

The OIG recommend that CMS:

  1. Provide additional guidance to states to help ensure that they meet the assurances.
  2. Require states that do not meet one or more assurances to develop corrective action plans.
  3. Require at least one onsite visit before a waiver program is renewed and develop detailed protocols for such visits.
  4. Develop a broader array of approaches to ensure compliance with each of the assurances.
  5. Make information about state compliance with the assurances available to the public. 

CMS agreed with 4 of the recommendations and partially concurred with the OIG’s recommendation to require onsite visits.