Medicaid Payments Should Depend on Personal Care Data

To improve the oversight of personal home care services paid for by Medicaid, the solution is simple: Withhold money from states if they do not furnish the data that federal agencies require for monitoring.

That was the idea put forward Tuesday by Rep. Chris Collins (R-NY) during a hearing of the Oversight and Investigations subcommittee of the House Energy and Commerce Committee.

The topic of the hearing was “Combating Waste, Fraud and Abuse in Medicaid’s Personal Care Services.” It was prompted by recent reports from the Department of Health and Human Services Office of Inspector General (OIG) and the Government Accountability Office (GAO), which have raised concerns about fraud, abuse and management issues in how state Medicaid programs administer personal care benefits, and how the federal government oversees and influences these programs.

One concern highlighted by the GAO: States are often not “timely, complete or consistent” in submitting personal care services data to the Centers for Medicare & Medicaid Services (CMS). Not having information such as provider identification numbers or data on the quantity of services provided hamstrings CMS’ efforts to oversee state programs, GAO has noted.

“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.”

In other words, because Medicaid is jointly funded by the states and the federal government, the federal funds could be withheld unless certain conditions are met.

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. She was joined at the hearing by two other witnesses: Christi Grimm, chief of staff at OIG; and Timothy Hill, deputy director of the Center for Medicaid and CHIP Services at CMS.

While acknowledging 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. He received support from 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 raised at the hearing. Pressed by Rep. Jan Schakowsky (D-IL), the witnesses 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. He asked the witnesses to share their recommendations for which states might be able to offer examples of best practices.