Senate Democrats are calling on the Government Accountability Office (GAO) to conduct a new review of how oversight is conducted over assisted living facilities that participate in Medicaid following a 2018 report that uncovered a stark lack of transparency and reporting across states.
Democratic Sens. Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.) and Ron Wyden (Ore.) wrote to the GAO, asking that the office provide an update to a 2018 report in which it found that federal oversight of the health and welfare of Medicaid beneficiaries in assisted facilities was lacking and allowing for abuse and neglect to go unnoticed.
The 2018 report found that more than half of state Medicaid agencies could not tell the GAO the number of critical incidents in assisted living facilities or the nature of these incidents. While some incidents — such as physical, emotional or sexual abuse — were identified in all states, some states did not identify incidents indicative of possible abuse, such as medication errors or unexplained deaths.
As the senators noted in their request, continued reporting in the following years found that violations at assisted living facilities were often not penalized.
"A new GAO report could provide legislators and the American public with a stronger understanding of why assisted living facilities were so rarely held accountable for neglecting the safety of their residents, and could pave the way for future rules, regulations, or laws that more effectively keep assisted living residents safe," they wrote.
They also cited the January 2024 testimony by witnesses from the assisted living space. Witnesses told senators that facilities are sometimes limited to operating in states where Medicaid programs make their model viable. Richard Mollot, executive director of the Long Term Care Community Coalition, said in the hearing that there was no "independent, validated information on assisted living" for families looking for care.
In their letter, Warren, Gillibrand and Wyden asked GAO how state Medicaid programs are currently monitoring the health and welfare of beneficiaries in assisted living facilities and if anything has changed since the 2018 report. They also requested to know what critical incidents have been identified in recent years as well as how CMS plans to implement the critical incident reporting requirements set to go into effect in the next few years.
Last year, the Centers for Medicare and Medicaid Services (CMS) finalized new requirements for state Medicaid programs to ensure they maintain an "incident management system that identifies, reports, triages, investigates, resolves, tracks, and trends critical incidents."
This reporting requirement will not go into effect until 2027. Beginning in 2029, states will also be required to maintain electronic incident management systems to keep track of critical incidents.
