May 28, 2024

Casten, Dingell Call for Patient Care Provisions in Final CMS Rule

Washington, D.C. - Today, U.S. Congressman Sean Casten (IL-06) and Congresswoman Debbie Dingell (MI-06) led nine colleagues in a letter urging Center for Medicare and Medicaid Services (CMS) Administrator Brooks-LaSure to implement quality standards of care and protections from abuse and neglect for older Americans and people with disabilities. 

“We recognize that CMS has taken significant steps toward protecting the care Medicaid beneficiaries receive, and we encourage the Center to go further by implementing the Access Rule provisions that prioritize patient care,” the lawmakers wrote. “CMS's work to combat abuse, neglect, and fraud is critical. Our shared responsibility is to ensure that the standard of care offered to seniors and disabled Americans is unparalleled. We look forward to your partnership in ongoing work to support Medicaid PCS patients and high-quality providers.”

Personal care services (PCS) is a Medicaid benefit to support older Americans and people with disabilities who live independently at home. Despite the high-quality, life-enhancing care many beneficiaries receive, CMS has been aware of concerns about abuse and neglect of beneficiaries by some PCS providers for many years. 

Last month, the Center for Medicare and Medicaid Services finalized the Ensuring Access to Medicaid Services rule, to establish more robust quality controls for Personal Care Services. The implementation of quality-focused components of this rule to strengthen person-centered service planning and care management is essential to supporting the safety, dignity, and self-determination of Medicaid beneficiaries who receive Personal Care Services.

In addition to Reps. Casten and Dingell, the letter was signed by Reps. Eleanor Holmes Norton, Jamaal Bowman, Donald Davis, Pramila Jayapal, Barbara Lee, Jan Schakowsky, Marilyn Strickland, Jonathan Jackson, and Raúl Grijalva. 

A copy of the letter can be found here and below. 

 

Dear Administrator Brooks-LaSure, 

We write to you today to express concern about the variable quality of care patients receive when enrolled with Personal Care Service (PCS) Providers or self-directing Personal Care Attendants through Medicaid and to seek your swift action to implement provisions within the Ensuring Access to Medicaid Services (Access Rule) final rule to establish more robust quality controls for Personal Care Service paid through Medicaid. In particular, we encourage the implementation of provisions within the final rule to establish stronger oversight of Home and Community-Based Services and to strengthen person-centered service planning and care management. 

We recognize that CMS has long been aware of concerns about abuse and neglect of beneficiaries by some PCS providers for many years. In response to ongoing concerns about abuse, neglect, and fraud, in 2012, the OIG published a portfolio report on PCS. This report observed improper payments linked to noncompliance with state requirements and poor documentation of care, inadequate controls to ensure appropriate quality of care and payment, and broader concerns about PCS fraud. Based on its findings, the OIG issued five recommendations, including recommendations that CMS promulgate regulations to reduce significant variation in state PCS attendant qualifications and laws, as well as recommendations to improve CMS and state's ability to monitor the quality of care and payments by requiring PCS attendants to register with CMS or the state.

In 2016, the Office of the Investigator General again published an Investigative Advisory urging CMS to take further action to prevent fraud, patient harm, and neglect in Medicaid PCS. This report highlighted fraud risks perpetrated by PCS agencies and Personal Care Attendants in self-directed programs, overbroad geographical service areas, and, most importantly, instances of patient harm. Based on its findings, the OIG recommended CMS take the following steps: 

  • Establish minimum federal qualifications and screening standards for PCS workers, including background checks. 

  • Require States to enroll or register all PCS attendants and assign them unique numbers.

  • Require that PCS claims identify the dates of service and the PCS attendant who provided the service.

  • Consider whether additional controls are needed to ensure that PCS services are allowed and provided under program rules

Since those recommendations were made, we recognize that CMS has taken significant steps toward protecting the care Medicaid beneficiaries receive, and we encourage the Center to go further by implementing the Access Rule provisions that prioritize patient care. In particular, we commend CMS for prioritizing person-centered care management. We are optimistic about the impact of CMS's final rule to require state Medical Care Advisory Committees (MCACs) to proactively and regularly include beneficiaries and consider a perspective borne of their lived experience as they implement high-quality Medicaid services. We are further buoyed by the creation of Beneficiary Advisory Committees. Defining and protecting the role of beneficiaries within MCACs is critical to ensuring that beneficiary prospective care will remain, as intended, at the heart of the implementation of Personal Care Services. Finally, providing additional guidance to states as they implement the MCACs as outlined in the final rule will ensure regulators hear beneficiaries’ voices in every state.

We strongly encourage CMS to convene a technical expert panel in line with and to build on the Access Rule and consult with stakeholders, including personal care service recipients, people with disabilities, seniors, disability rights advocates, small and large personal care service providers, and unions or other entities that represent individual Direct Service Providers to establish a plan to implement many of the recommendations of the OIG and explore other program integrity supports and safeguards which may be needed. 

CMS's work to combat abuse, neglect, and fraud is critical. Our shared responsibility is to ensure that the standard of care offered to seniors and disabled Americans is unparalleled. We look forward to your partnership in ongoing work to support Medicaid PCS patients and high-quality providers.

 

###