Amid all the talk about vaccination mandates, an interesting document has emerged that offers a reminder of the extent to which COVID-19 has upended the world of home- and community-based services.
The Government Accountability Office (GAO), Congress’ watchdog, just released a report recommending that the Centers for Medicare & Medicaid Services develop procedures to carefully monitor the temporary changes states made to their HCBS programs during the pandemic. It also recommended that CMS evaluate these modifications and address opportunities for improvement.
Embedded in the report is information that reveals in detail how states created workarounds to address safety precautions and help providers with costs related to the crisis. For its report, GAO examined six states, Massachusetts, Washington, Wyoming, Illinois, Rhode Island and North Carolina. A few facts and figures from the document regarding these selected states:
- Four states in 2020 reported HCBS payment increases totaling $450 million, ranging from $3 million in Rhode Island to $360 million in Washington.
- Washington has increased payment rates for providers up to 50%.
- Thirty-nine states used retainer payments, which were time limited, to help providers stay in business through disruptions caused by the pandemic. Five of the six selected states that implemented retainer payments reported total payments of at least $98 million in 2020, ranging from $2 million in Washington to $59 million in Illinois.
- Some investigations of potential or actual harm to beneficiaries have been delayed or postponed as a result of the public health emergency. In one state, reports of financial exploitation took the backseat to more severe incidents, such as abuse and neglect.
- Reports of abuse or neglect fell in the absence of more routine in-person contact with beneficiaries, creating concerns that incidents were not being reported.
It’s worth noting that the pandemic ushered in HCBS adaptations at an unusual frequency. As a result of the scope of the crisis, CMS approved an “unprecedented number of temporary changes,” GAO said in its report.
As warranted as those state changes may have been, an emergency should not be an excuse to game the system or introduce potential for harm to seniors. GAO is taking the right approach in pressing pause and asking CMS to take careful stock of all the recent HCBS activity.
Liza Berger is editor of McKnight’s Home Care. Follow her @lizaberger19 or email her at [email protected].
This article originally appeared on McKnight's Senior Living
