OIG: Assisted living needs to up information, compliance levels on HCBS

Concerns about home- and community-based services (HCBS) at assisted living facilities were raised in a report released Tuesday by the Health and Human Services Office of Inspector General.

The OIG is asking the Centers for Medicare & Medicaid Services to put out more guidance on HCBS compliance with federal requirements. Assisted living programs might not be giving enough information about access to HCBS funds, the agency said. Methods for eligibility include Section 1915 c waivers or Section 115 research and demonstration waivers. The 1915 c waiver allows Medicaid to cover HCBS, but the OIG wants more information about the services, their compliance to the plan and their cost.

In 2009, 35 state Medicaid programs reported that they covered HCBS for more than 54,000 beneficiaries. This involved about 12,000 ALFs at an annual cost of $1.7 billion, according to OIG.

The OIG said it selected seven states with the highest numbers of beneficiaries that did not completely comply with the federal provider standards. In the group, more than three-quarters of beneficiaries received HCBS in ALFs that were cited for noncompliance with at least one state requirement. Nine percent of beneficiaries' records did not include plans of care, and more than 40%  did not include HCBS frequency data, officials said.

CMS agreed with the OIG recommendation to issue more guidance to state Medicaid programs and emphasize compliance with federal requirements. Click here to see the report.