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HRD-77-129 1 (1977-08-16)

handle is hein.gao/gaobaacov0001 and id is 1 raw text is: DOCUM!NT PEStJMF 03148 - rA23534661 fReview of Systems Use by Georgia and Tennessee in 1975 and 1qI6 to Assure that the Care Received by Medicaid Patients in Tntermediate Care Facilities Was Properi. HPD-77-129; R-164031 (3 _ August 16, 19'77. 1- pp. Report to Secretary, Department of Health, Education, and Welfare: by James D. Martin (for Gregory J. Ahart, Director, Ruman Pesources Div.). Tssue Area: HeElth Programs: Compliance With Financing Laws anfi FCaulaions (1207) ; Health Programs: Quality Care and its Assurance (1213) ;Health Programs: Efficiency and T':fctivencss of G zantees and Contractors in Providing raatm-rt Servicrs (121-,). Cor+act: Human . . ources Div. Budet runc+ion: Health: Health Care s-rvices (551) ; Fealth: Nirsinq Homes (F51. Organization Concerned: Health Care Financing Administration. Conqressional Relevance: House Committee on Interstate and Foreign Commerce; Senate Commite-e on Finance. Authoritv: Social SociriAv menments of 19'1 (42 U.S.C. 1396r). Q5 C.P.R. 250.24. A review of +he systems used by Georgia and Tennessee in 107r an! 1q76 to assure that the care received by Medicaid ra~ients ir in+ermadiat- care facilities was appropria~e irfict d +hat +he State systems were not functioning properly. ri:i1nqs/Conclusions: Iedicid payments were beinq male for in+ormedi0a+e care facilities patients even though required written evaluaticns an' plans of care were oissing or incomlel-e. Wi+hout such evaluat-ions and plans of ce:e, farc ii4-is could not have adequately treated thesc? patients, anr h- 4p cial neFds of mentallv retarded pation+ coald nt have 1--n identified and met. F aeral regal- ions -,d that oavont s should rot have been anthcrized for s, pitients unless +heir condition was independently evalu ed and a written Dlan of care was developed. 7tate surveys did not identify many deici-nci-s in +he caro providod to intermediate care facility oa+.iants. Recommendations: To better assure tiat intermediate care facilis-ies provide proper care to Medicaid pa-ien+s, the S'cretarv of Health, Fduca+ion, and Welfare shculi lirect the Alminis4ra+or of the Health Care Financing Administration to: rauire +he S*ats to s+op authorizing reimbursements for pjai4-in+ in these facilities who do not have wri+fen plans o' care and evaluations of +heir nqeds; assist States to iinprcve 4h-ir -urvays of intermalia+e carp facilities; and use +he rnsul+s of !tata surveys and independent professional reviews in coordina+ion with additional validation surveys +o better valiai*e F4ate activities and assist them in improving their inernadiatp care facilities programs. (SC)

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