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On Feb. 5, the GAO released a report entitled “Medicaid Assisted Living Services: Improved Federal Oversight of Beneficiary Health and Welfare Is Needed.” The report comes in response to a 2015 request from Sens. Collins (R-ME), McCaskill (D-MO), Warren (D-MA) and Hatch (R-UT) for a review of Medicaid spending, and federal and state oversight of care provided to Medicaid enrollees in assisted living. At that time, and periodically over the past two years, Argentum has provided information to the four senators and the GAO on how assisted living is regulated, profiles of the average resident and provider, and on Medicaid utilization in assisted living.

Rationale for the Study
The GAO report describes the following rationale for executing the study:

GAO Recommendations
The GAO surveyed all state Medicaid agencies and interviewed officials in three states: Georgia, Nebraska, and Wisconsin. The GAO also reviewed regulations and interviewed CMS officials.  In response, they made the following three recommendations to CMS:

  1.  The Administrator of CMS should provide guidance and clarify requirements regarding the monitoring and reporting of deficiencies that states (state Medicaid agencies) using HCBS waivers are required to report on their annual reports.
  2. The Administrator of CMS should establish standard Medicaid reporting requirements for all states (state Medicaid agencies) to annually report key information on critical incidents, considering at a minimum, the type of critical incidents involving Medicaid beneficiaries, and the type of residential facilities (including assisted living) where critical incidents occur.
  3. The Administrator of CMS should ensure that all states (state Medicaid agencies) submit annual reports for HCBS waivers on time as required.

Points of Interest
Additional summary points of the GAO report include:

The report was mainly concerned about the health and safety of Medicaid beneficiaries living in assisted living. The study identified some areas of weakness in defining critical incidents, reporting of this information to Medicaid agencies, and making this information available to the public. Specifically the report noted the following:

Next Steps
Argentum is meeting with the four senators who requested the report, as well as other members of the U.S. Senate Committee on Aging to discuss the findings. Of particular note: the GAO report included data on younger disabled residents in their findings on Medicaid funding in assisted living. Argentum has reached out to GAO to try to gain clarity on how much of the report pertains to seniors and how much is relevant to younger disabled populations.


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