Report Criticizes Federal Oversight of State Medicaid

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> Report Criticizes Federal Oversight of State Medicaid

> Mon Jul 7, 2:53 PM ET

> By ROBERT PEAR

>

<http://us.rd./dailynews/nyt/ts_nyt/byline/SIG=4fh49n/*http://www.n

ytimes.com>The

> New York Times

>

> WASHINGTON, July 6 The Bush administration has allowed states to make vast

> changes in Medicaid but has not held them accountable for the quality of

> care they provide to poor elderly and disabled people, Congressional

> investigators said today.

> or

>

> The administration often boasts that it has approved record numbers of

> Medicaid waivers, which exempt states from some federal regulations and

> give them broad discretion to decide who gets what services.

>

> But the investigators, from the General Accounting Office

>

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<http://us.rd./DailyNews/manual/*http://search./bin/search

?cs=nw & p=General%20Accounting%20Office>web

> sites), said the secretary of health and human services

>

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> sites), Tommy G. Thompson, had " not fully complied with the statutory and

> regulatory requirements " to monitor the quality of care under such

waivers.

>

> The accounting office examined 15 of the largest waivers, covering

services

> to 266,700 elderly people in 15 states and found problems with the quality

> of care in 11 of the programs. In many cases, Medicaid beneficiaries

simply

> did not receive the services they were supposed to receive.

>

> The Medicaid beneficiaries were all eligible for nursing-home care but

> chose to stay in the community with friends and relatives. Rather than pay

> the high cost of institutional care, the states promised to provide a wide

> range of social and medical services known as home and community-based

care.

>

> The General Accounting Office said, however, that the states often failed

> to provide those services and that the federal Department of Health and

> Human Services

>

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> sites) took no action to protect patients.

>

> The federal government and the states spent more than $258 billion on

> Medicaid last year, with the federal share accounting for 57 percent.

>

> Thomas A. Scully, administrator of the federal Centers for Medicare and

> Medicaid Services, said in an interview that he was " not aware of the

> extent of the problem. "

>

> In written comments included in the report, Mr. Scully said states were

> responsible for " quality assurance. " For the federal government to review

> the quality of care provided under every waiver, he said, would require a

> new investment of millions of dollars and hundreds of additional federal

> employees. In any event, he said, federal inspectors should not be

marching

> through private homes to evaluate care.

>

> The study was requested by Senators Charles E. Grassley, Republican of

> Iowa, and John B. Breaux, Democrat of Louisiana. They favor home and

> community care as an option under Medicaid, but expressed alarm at the

> findings in the report.

>

> " These waivers should be put on hold until the department gets a handle on

> the quality of care going to older and disabled Americans, " said Mr.

> Grassley, the chairman of the Senate Finance Committee. " Right now there's

> no accountability, and that's wrong. "

>

> In a letter to Secretary Thompson, the senators asked the Bush

> administration to submit a detailed plan for corrective action by July 28.

>

> The effect of a waiver is to exempt a state from certain provisions of

> federal law and regulations. Waivers allow states to provide services in

> selected geographic areas or to specific populations and to limit the

> number of people served or the total spent, actions not usually allowed

> under the Medicaid statute.

>

> For years, Medicaid favored institutional care. Congress authorized home

> and community care as an alternative in 1981.

>

> Since 1992, the number of Medicaid beneficiaries receiving such care under

> federal waivers has tripled, to 800,000, and it is expected to continue

> growing. With waivers, states can tailor services to individual patients,

> including those with Alzheimer's disease

>

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> sites), traumatic brain injuries, mental retardation and AIDS

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> sites).

>

> More than half the people receiving home and community care under Medicaid

> waivers are 65 or older. They receive all sorts of therapy, as well as

> assistance with bathing, dressing, shopping and other essential activities

> they cannot perform themselves. In some states, the patients direct their

> own care, by hiring and training their own workers.

>

> Medicaid spending on such care soared to $15 billion last year, from less

> than $2 billion in 1992.

>

>

>

> As former governors, President Bush

>

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<http://us.rd./DailyNews/manual/*http://search./search/sea

rch?p=George+W.+Bush>web

> sites) and Mr. Thompson have repeatedly said they want to give states more

> control over Medicaid by speeding the approval of federal waivers.

>

> Sara Rosenbaum, a professor of health law and policy at George Washington

> University, said: " States prepare good plans of care for Medicaid

> recipients, but there's no follow-through to see if people get the care.

> States assume that home and community care will save money, without

> realizing that it takes real money to monitor the quality of care. "

>

> The Congressional investigators found " medical and physical neglect " of

> some Medicaid recipients. But they said the full extent of such problems

> was unknown, because no one was enforcing basic safety and hygiene

> standards or systematically reviewing patients' records.

>

> More than a dozen state waiver programs covering tens of thousands of

> people have gone more than a decade without any federal review of the

> quality of care, the accounting office said. These programs were in

Hawaii,

> Idaho, Iowa, Louisiana, Missouri, New Mexico, Oklahoma and Texas.

>

> A waiver is normally approved for three years and can be extended, at a

> state's request, for five years at a time if the state shows that it has

> safeguards to protect the health and welfare of Medicaid beneficiaries.

But

> the accounting office said federal officials had renewed many waivers

> without confirming that states had such safeguards.

>

> Many states sign contracts with social service agencies to manage care for

> Medicaid recipients, but never review the quality of care or verify that

> services were actually provided, the report said. In Oklahoma, it said, 27

> percent of Medicaid recipients received none of their authorized personal

> care services, and 49 percent received only half of the authorized

services.

>

> Maureen Booth, a health policy expert at the University of Southern Maine,

> said the strengths of home and community care also complicated the task of

> guaranteeing its quality.

>

> " The beauty of home and community care is that it's flexible, it responds

> to the needs of individual patients with a cadre of support workers, " Ms.

> Booth said. " But to improve quality, you have to reach a whole myriad of

> workers employed by multiple agencies. "

>

>

>

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