OIG HHS Report Finds Eleven States Improperly Restricted Home Health Eligibility
July 15, 2013 08:47 AM
On July 1, the Office of Inspector General of the Department of Health and Human Services (the OIG) sent a Memorandum Report (the Report) to Marilyn Tavenner, the Administrator for the Centers for Medicare & Medicaid Services, evaluating the states' eligibility requirements for Medicaid Mandatory Home Health Services. The Report found that eleven states had improper restrictions on eligibility requirements by including a requirement that the patient be homebound.
In the early 1990s, NAHC was successful in advocating that the Medicare-like "homebound" requirement for Medicaid home health services violated federal Law and the Americans with Disabilities Act (ADA). Since that time, some states had resisted changing their coverage standards to comply with the law. Subsequent complaints lead CMS to issue a Medicaid Directors Letter and to proposed changes in the formal Medicaid regulations to prohibit any homebound requirement.
The OIG evaluated the state plans and other policies that defined eligibility criteria for the benefits for all 50 states and the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands (the Report referred to all 54 of these entities as States).
Of these States, the OIG found that eleven violated federal regulations by restricting eligibility for home health benefits to homebound individuals. The National Council on Medicaid Home Care, a NAHC affiliate, analyzed the report’s findings. The full article can be found here.