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GAO Highlights the Need to Improve Personal Care Services Data Submissions to CMS

Posted on Wednesday, May 3, 2017 1:03 PM

In order to see improvement in personal home care services paid for by Medicaid, money must be withheld from states that don’t provide the data federal agencies require for monitoring. Rep. Chris Collins (R-NY) brought forward that idea during a hearing of the Oversight and Investigations subcommittee of the House Energy and Commerce Committee.

The topic was based around “Combating Waste, Fraud and Abuse in Medicaid’s Personal Care Services.” The hearing was driven by recent reports from the Department of Health and Human Services Office of Inspector General (OIG) and the Government Accountability Office (GAO).

The GAO highlighted one major concern: States are often not “timely, complete or consistent” when it comes to submitting personal care services data to the Centers for Medicare & Medicaid Services (CMS). GAO also noted that not having information such as provider identification numbers or data on the quantity of services provided hamstrings CMS’ efforts to oversee state programs.

“I’m dumbfounded,” Collins said of the current situation with data collection.

The solution is simple, he proposed: Tying payments to timely submission of data.

“The minute you cut off the funds, [you get the data],” he said. “Money talks.”

As for why this solution hasn’t already been enacted, one concern is maintaining beneficiaries’ access to services, said Katherine Iritani, Director of Health Care at the GAO. Iritani was had two witnesses that joined her during the hearing: Christi Grimm, chief of staff at OIG; and Timothy Hill, deputy director of the Center for Medicaid and CHIP Services at CMS.

In response to the need for beneficiaries to have care, Collins said that a “just do it” attitude is needed at this point with regard to getting required data. Collins was accompanied by Rep. Tim Walberg (R-MI), who said that it’s “time to push” and financial levers might be the way to do that.

Caregiver training was another issue brought up during the hearing. Rep. Jan Schakowsky (D-IL) stated that currently states vary on requirements for personal care attendant training and orientation, including on the subject of what constitutes waste, fraud and abuse.

CMS has put out best practices with regard to worker training, but he could not identify off the top of his head which states require training on the topic of waste, fraud and abuse, Hill said.

“The word has gone out that this would be important, but nothing is being done to enforce that or survey what’s being done on worker training,” Schakowsky said.

Hearing from people involved in personal care programs at the state level might be a good next step, said Rep. Tim Murphy (R-PA), Chairman of the Subcommittee, at the conclusion of the hearing.

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