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GAO finds improved oversight of state Medicaid payment structures needed in MLTSS

In two January 2017 reports filed by Government Accountability Office (GAO), the agency found that:

  1. CMS’ oversight of state payment structure regarding Medicaid funding was limited.
  2. Data collected from the Centers for Medicare & Medicaid Services’ (CMS) systems used to describe the distribution of and spending on Medicaid personal care services is limited due to data gaps and errors; and

As a result of findings detailed in the first report, GAO recommends CMS:

  • Require all states to report on progress toward achieving Medicaid managed long-term services and supports (MLTSS) program goals
  • Establish criteria for what situations would warrant exceptions to federal standards for data used to set rates
  • Provide guidance with minimum standards for validating encounter data.

As a result of findings detailed in the second report, GAO recommends that CMS establish standard reporting guidance for key data, ensuring that the data aligns with services provided. Under these recommendations CMS will need to use the data collected to increase oversight of state Medicaid funding, including increased attention to states’ compliance with reporting regulations.

HHS agrees with all three of GAO’s recommendations in the second report, and agrees with recommendations in the first report that state compliance be confirmed and that plans be developed to better utilize collected data.