Conflicts of Interest Mar HCBS

States’ efforts to provide home- and community-based services to elderly and disabled Medicaid beneficiaries who need assistance to continue living independently continue to be plagued with conflicts of interest that the Centers for Medicare & Medicaid Services is not adequately addressing.

Or so concludes a new study published by the U.S. Government Accountability Office.

According to the GAO,

…conflict of interest remain in regard to HCBS providers and managed care plans.  HCBS providers may have a financial interest in the outcome of needs assessments, which could lead to overstating needs and overprovision of services.  CMS has addressed risks associated with HCBS provider conflicts, such as by requiring states to establish standards for conducting certain needs assessments, but these requirements do not cover all types of HCBS programs.

To address this problem, the GAO recommends

…that all Medicaid HCBS programs have requirements for states to address both service providers’ and managed care plans’ potential for conflicts of interest in conducing assessment.

The study notes that the U.S. Department of Health and Human Services concurs with the GAO recommendations.

Learn more about the challenges facing the delivery of home and community-based services in the GAO report CMS Should Take Additional Steps to Improve Assessments of Individuals’ Needs for Home- and Community-Based Services, which can be found here.

 

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