Home-Based Waivers Scrimp on Quality, GAO Says

Washington

For the past decade, Medicaid-eligible seniors have been moving home from institutions, thanks to a “home- and community-based service” waiver program that allows states more latitude to develop alternatives to nursing-home care. Yet while these alternatives have grown steadily in popularity, they may scrimp on quality, according to a July 7 report from the U.S. General Accounting Office.

“More than 70 percent of the waivers for the elderly that GAO reviewed documented one or more quality-of-care problems,” the report said. “The most common problems included failure to provide necessary services, weaknesses in plans of care and inadequate case management.”

States and the federal government share responsibility for these problems, the report explained, noting an overall lack of governmental oversight of the HBCS waiver programs.

To raise the bar for quality care, the Baltimore-based Centers for Medicare and Medicaid Services should do more to define the parameters of states’ waiver programs, requiring states to implement rigorous quality-assurance safeguards, the GAO said. “The 10 CMS regional offices are responsible for ongoing monitoring for HCBS waivers. However, CMS does not adequately monitor state waivers and the quality of beneficiary care.”

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