Review of Systems Used by Georgia and Tennessee in 1975 and 1976 to Assure that the Care Received by Medicaid Patients in Intermediate Care Facilities Was Proper

HRD-77-129: Published: Aug 16, 1977. Publicly Released: Aug 16, 1977.

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A review of the systems used by Georgia and Tennessee in 1975 and 1976 to assure that the care received by Medicaid patients in intermediate care facilities was appropriate indicated that the state systems were not functioning properly.

Medicaid payments were being made for intermediate care facilities patients even though required written evaluations and plans of care were missing or incomplete. Without such evaluations and plans of care, facilities could not have adequately treated these patients, and the special needs of mentally retarded patients could not have been identified and met. Federal regulations provided that payments should not have been authorized for such patients unless their condition was independently evaluated and a written plan of care was developed. State surveys did not identify many deficiencies in the care provided to intermediate care facility patients.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: To better ensure that intermediate care facilities provide proper care to Medicaid patients, the Secretary of Health, Education, and Welfare should direct the Administrator of the Health Care Financing Administration to: (1) require the states to stop authorizing reimbursements for patients in these facilities who do not have written plans of care and evaluations of their needs; (2) assist states to improve their surveys of intermediate care facilities; and (3) use the results of state surveys and independent professional reviews in coordination with additional validation surveys to better evaluate state activities and assist them in improving their intermediate care facilities programs.

    Agency Affected:

 

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