GAO Tells CMS to Better Track COVID Changes to HCBS

WASHINGTON, D.C. (September 10, 2021)—The Government Accounting Office (GAO) is urging the Centers for Medicare & Medicaid Services (CMS) to better track the effects of pandemic-related changes on programs for home- and community-based services (HCBS). The changes include allowing evaluations by telehealth, allowing other settings for care and relaxing provider qualifications.

“Without a full evaluation, CMS may miss opportunities to better prepare for future emergencies,” the report concluded.

The recommendation came out of a report the GAO recently issued in which it studied the temporary changes approved by CMS to allow for safer provision of HCBS during the COVID-19 pandemic. The office interviewed Medicaid officials from CMS and six states and looked at CMS’ pandemic plan and federal internal control standards. It found that, although CMS’ own plans call for evaluation to allow for mid-course review, there was not a system for doing so.

“CMS had no procedures for monitoring temporary changes during an emergency,” the report found. Instead, states had the primary responsibility to monitor changes but CMS didn’t require them to share data and provided limited guidance, the report says.

It also said that agency officials told GAO that they intend to evaluate the changes to HCBS programs, but had not yet developed plans to do so—and some required reports won’t be due for more than three years.

The report found that 38 states increased payment rates by 5% to 50% for HCBS providers during the pandemic; 25 states allowed increases to in-home services. All states and the District of Columbia allowed virtual visits to determine eligibility; 49 expanded service settings; and 42 allowed for longer service limits.

It also concluded that, while the temporary measures did allow for more patient contact without viral transmission, some challenges emerged. For example, it said that the reduction in in-person visits meant providers were more likely to miss problems in the home such as safe entry/egress, bathroom access and medication management. Reports of abuse and neglect fell and some investigations of reported incidents, including financial exploitation, were delayed or postponed.

“Officials in one state said that after resuming in-person visits, case managers have observed problems with beneficiaries’ quality of life or living conditions that could have been caught earlier through in-person assessments,” the report said. “For example, case managers observed the need for additional durable medical equipment, home modifications, and assistive technology.”

You can read the full report here.