OIG Releases Report On Medicaid Services In Adult Day Health

The Office of the Inspector General (OIG) released the report Medicaid Services Provided in an Adult Day Health Setting (OEI-09-07-00500), which focused on 12 states that, as of Dec. 31, 2007, provided nursing- and therapy-focused adult day health services through a state plan benefit to primarily elderly or disabled individuals.

Using medical reviewers, OIG reviewed a random sample of 300 adult day health service days from the last 6 months of 2007. The report states that beneficiaries received at least 1 health service on 60% of service days.  

OIG Findings

Within broad federal Medicaid requirements, individual states establish the specific requirements that must be met for Medicaid reimbursement of adult day health services. OIG found that:

• Meals and/or snacks were the only documented services for Medicaid beneficiaries on 34% of service days in an adult day health setting. 
• Approximately 43% of therapy services were provided by staff who did not receive the required supervision.  
• Although documentation associated with most service days included timely assessments, in some cases documentation lacked appropriate physician orders or was inconsistent with plans of care.  

OIG Recommendations

The OIG recommends that the Centers for Medicare and Medicaid Services (CMS):

• Specify what services are required for Medicaid reimbursement of adult day health services.
• Direct states to enforce supervision requirements for staff who provide therapy services in Medicaid adult day health centers.
• Take appropriate action to address the centers that did not respond to repeated data requests. 

In its written comments on our draft report, CMS concurred with all of our recommendations and outlined the steps it will take to implement them. 

The 12 states OIG focused on in the report are: 

• California
• Maine
• Maryland
• Massachusetts
• Missouri
• New Hampshire
• New Jersey
• New York
• Nevada
• Texas
• Washington
• Vermont