CMS to Improve State Oversight of HCBS

The Centers for Medicare and Medicaid Services (CMS) is continuing its effort to improve how states monitor health and welfare in Home and Community-Based Services (HCBS). This effort, which includes technical assistance to select states, is part of the federal government’s overall health care fraud and abuse control program that was featured in a recent report.   

Under federal Medicaid law, states are required to report to CMS information on the health and welfare of Medicaid HCBS enrollees and have written into 1915(c) waivers assurances from the state on how they will monitor critical incidents related to health and welfare.

In the last few years, other federal agencies have published reports finding that states are not carrying out this function consistently or adequately. For example, one report found that more than half of states could not report the number of critical incidents that took place in assisted living facilities, often because the state did not have adequate tracking systems in place.

As a result of these reports, CMS launched the Health and Welfare Special Review Teams in 2018 to work with states on improving how they monitor health and welfare. Over a three-year period, CMS is providing technical assistance to selected states to identify and resolve problems states are having in this area. They are also surveying state agencies administering HCBS programs.

CMS is prioritizing technical assistance for states with HCBS programs up for renewal, states with identified promising practices and/or challenges monitoring health and welfare, and those that request it. CMS will also be conducting site visits to states, which may include visits to certain providers.

LeadingAge will continue to monitor this effort, offer feedback to CMS as needed and keep our members apprised of developments with the Health and Welfare Special Review Teams.

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