NYSACRA

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OVERVIEW
                                                                
Home and community-based settings have become a growing
part of  states' Medicaid long-term care programs, serving as an      
alternative to care in institutional settings, such as nursing     
homes. To cover such services, however, states often obtain     
waivers from certain federal statutory requirements. GAO was     
asked to review (1) trends in states' use of Medicaid home and     
community-based service (HCBS) waivers, particularly for the     
elderly, (2) state quality assurance approaches, including     
available data o­n the quality of care provided to elderly     
individuals through waivers, and (3) the adequacy of federal     
oversight of state waivers. GAO is recommending that the     
Administrator of CMS take steps to (1) better ensure that state 
quality assurance efforts are adequate to protect the health and
welfare of HCBS waiver beneficiaries, and (2) strengthen federal
oversight of the growing HCBS waiver programs. Although CMS     
raised certain concerns about aspects of the report, such as the
respective state and federal roles in quality assurance and the 
potential need for additional federal oversight resources, CMS     
generally concurred with the recommendations.

[GAO-03-561 ] Nursing Home Quality: Prevalence of Serious Problems, While Declining, Reinforces Importance of Enhanced Oversight

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