Health Care: Limited State Efforts to Assure Quality of Care Outside Hospitals

GAO discussed the extent to which states licensed, inspected, and imposed sanctions on non-hospital health care facilities to protect consumers from poor-quality health care. GAO noted that: (1) states generally required only alcohol and drug abuse treatment centers, ambulatory surgery centers, and home health care agencies to obtain operating licenses and typically allowed 13 other types of freestanding providers to operate without licenses; (2) states that required licenses required providers meet quality assurance requirements involving credentials, quality assurance plans, peer review, and complaint resolution; (3) states reported meeting or exceeding required inspection frequencies 75 to 100 percent of the time; (4) states imposed few sanctions for deficiencies identified during inspections, citing lengthy appeals processes and the lack of intermediate sanctions; (5) state officials expressed concerns about ensuring quality of care provided by freestanding health care facilities; (6) states' plans for expanding licensing requirements were limited to one or two types of freestanding providers; and (7) 23 states lacked a system for receiving and resolving complaints for licensed or unlicensed freestanding providers.