Home Health & Hospice Week

GAO notes states' increase in home care options.

The Affordable Care Act appears to be do-ing its job when it comes to encouraging Medicaid use of home care. So suggests a new Government Accountability Office report.

The ACA established two new Medicaid home care programs with financial incentives: the Community First Choice and Balancing Incentive Program. And the health care reform law revised two existing programs -- Money Follows the Person and the 1915(i) state plan option.

As of this April, 13 more states had received $621 million in Money Follows the Person grants, the report notes. One state had applied for Commun-ity First Choice, four had applied for BIP, and three states received approval from the Centers for Med-icare & Medicaid Services to offer the revised 1915(i) option.

Stay tuned: The U.S. Supreme Court has upheld the ACA. But you may still see some of the options available under the law dismantled if its political opponents are successful in their attempts at repeal or revision.

In the meantime, the HHS Office of In-spector General examined oversight of quality of care in Medicaid home care programs. In fiscal year 2010, Medicaid expenditures for home and community-based services (HCBS) waiver programs serving the disabled or elderly totaled an estimated $8.9 billion, the OIG says in a new report.

"Strong oversight of waiver programs is critical to ensuring the quality of care provided to HCBS beneficiaries," the OIG says. "The beneficiaries who rely on HCBS waiver programs are among Medicaid's most vulnerable, and the nature of these programs puts beneficiaries at particular risk of receiving inadequate care."

Problem: "Seven of the twenty-five States that we reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries," the OIG found in its study.

Solution: The OIG wants CMS to provide more HCBS guidance to states; require plans of correction from states that don't meet quality oversight standards; require onsite visits of HCBS programs; and make quality information public. CMS agreed with the recommendations. However, "we believe that the efficacy of a site visit must be evaluated prior to any decision to conduct a site visit," the agency pointed out in its comments on the report. When a state meets all its quality standards, for example, "the agency reserves the discretion to determine that a site visit may not be required."

The GAO report is online at www.gao.gov/products/GAO-12-649 and the OIG report is at http://oig.hhs.gov/oei/reports/oei-02-08-00170.asp.