GAO Review of Managed Long Term Care and Services

The Government Accountability Office (GAO) recently released a report following its review of states’ implementation and CMS’s oversight of managed long-term care and services (MLTSS). Currently, 22 states use MLTSS programs to cover beneficiaries who need long-term support – MLTSS is seen as a way of expanding home and community based care programs. However, upon reviewing the methods used in six states (Arizona, Delaware, Kansas, Minnesota, Tennessee and Texas) to monitor access and quality in MLTSS programs, GAO found that states varied in the quality of their reporting and data-gathering. These variations concerned GAO because states were not collecting all the information necessary for CMS’ review of MLTSS programs for compliance with federal regulations. Therefore, GAO is worried that CMS may not be able to reliably detect state or MCO practices that do not meet federal guidance. To remedy this, GAO recommends that CMS take steps to identify and obtain information to oversee key aspects of MLTSS access and quality, including network adequacy, critical incidents, and appeals and grievances. HHS concurred with GAO’s recommendation. Read a summary of the report here, and the full report here.