“The Centers for Medicare & Medicaid Services needs better data to be able to ensure that it does not overpay for personal care services and to reduce the risk of fraud occurring, the Government Accountability Office said in a January report made public on Monday. Medicaid spent approximately $80 billion to provide assistance with activities of daily living in home- and community-based settings such as assisted living communities in 2014, the report noted. The amount exceeds spending on institutional long-term care, according to the GAO, and is expected to increase along with the demand for such services.”
LTC Comment (from Stephen A. Moses, President, Center for Long-Term Care Reform):
The HCBS rebalancing chickens are coming home to roost. As we’ve pointed out all along, managing provider payments and care quality in thousands of smaller venues is much tougher than under the economy of scale achievable in nursing home settings.
GAO: CMS needs better data to prevent HCBS overpayments, fraud