DOCUMENT RESUME 03365 - A23735171 Supplemental Security Income Overpayments to Medicaid Nursing Rome esidents Can Be Reduced. RD-77-131; B-164031 (4). August 23, 1977. 12 pp. + 2 appendices (3 pp.),. Report to the Congress; by Elmer B. Staatj, Comptroller General. Issue Aree- Income Security Programs: Program Monitoring and Administration (130). Contact: Human Resources Div. Budget Function: Income Security: ulblic Assistance and ther Income Suppleients (604); Health: Nursing omes (557). Organization Concerned; Department of Health, Education, and Welfare; Health Care Financig Administration; Socil Security Administration. Congressional Relevance: Fouse Committee on Ways and eans; Senate Committee on Finance; Congress. Authority: Social Security Act, as amended (42 U.S.C. 382-1382f (Supp. V)). Social Security Amendments of 1972 (42 .S.c. 1381 (Supp. Y)). 20 C.F.R. 416.705. when recipients of Supplemental Security Income enter nursing homes, their payments should b reduced because dicaid pays the cost of nursing home care. Findings/Conc.usions: In 1975, overpayments of about $7.6 million were made to recipients in California and Florida because the SocialSS!Security Administration (SSA) d not know that the recipients had been admitted to nursing homes. The majority of these overpayments could have been prevented through timely reporting of nursing home admissions. Social Security regulations require the recipient, or person authorized to accept his payments, to report admissions, but only 3% of admissions reviewed by GAD were reported. The regulations do not establish other methods for obtaining the information, Some SSA district offices, on their own initiative, made informal arrangements with nursing homes to report admissions, and with proper encouragement, this was found to be an effective means of obtaining timely reports. Recommendations: The Commissioner of SSA should: reqcire the district offices to provide forms to nursing homes for reporting admissions: and actively work with the nursing homes to obtain timely reports. The Administrator of the Health Care Financing Administration should have the States establish procedures requiring nursing homes participating in the edicaid program to report admissions of recipients to district offices promptly. (Author/HTW) REPORT TO THE CONGRESS BY THE COMPTROLLER GENERAL v:"+ ". OF THE UNITED STATES Supplemental Security Income Overpaymeits To Medicaid Nursing Home Residents Can Be Reduced Department of Health, Education, and Welfare Social Security Administration Health Care Financing Administration Admission to a nursing home should result in a reduction of Supplemental Security Income benefits because the indiidual's care is pro- vided under the Medicaid program. Supple- mental Security Income overpayments, how- ever, are made because the Social Security Administration is not aware of recipient admissions to nursing homes. In California and Florida these overpayments amounted to $7.6 million during 1975. Social Security's reliance on recipients to report admissions has not been effective. Nursing homes are a good :-3urce of information on admissions, and UAO recommends hat they be used to report recipient admissions. HRD-77-131 AUGUST 23, 1977 COMPTROLLIR GOINtEL OF THE U.ITO STATEI WASHINGOTON, D.C. 0MI41 B-164031(4) To the President of he Senato and the Speaker of the House of Representatives The Social Security Administration needs more timely reports of Supplemental Security Income recipients' admit- tance to nursing homes. Accurate reporting information would greatly reduce overpayments made to program recipi- ents. Procedures should be developed to obtain such reports from nursing homes. We made our review at te request of Senator Birch Bayh. We are sending copies of this report to the Director, Office of Management and Budget; the Secretary of Health, Education, and Welfare; the Commissioner of the Social Security Administration; and the Administrator of the Health Care Financing Administration. Comptroller General of the Unite States COMPTROLLER GENERAL'S SUPPLEME"TAL SECURITY INCOME REPORT TO THE CONGRESS OVERPAYMENTS TO MEDICAID NURSING HOME RESIDENTS CAN BE REDUCED Department of Health, Education, and Welfare Social Security Administration Health Care Financing Administration L I G E S T The Social Security Administration has nad many poblems in administering the Supple- mental Security Income program since it began in January 1974. Social Security estimates, based on its quality assurance data, that it has overpaid Supplemental Security Income recipients about $600 mil- lion annually during the period July 1974 tnrough June 1976. This report is directed at overpayments to such recipients in nursing homes. Under current law, the basic Federal Supplemental Security Income monthly payment for an individual is $177.80. (See p. 1., When a Supplemental Security Income recipient enters a nursing home for an expected stay of a full calendar month or longer, the pay- ments should be reduced to not more than $25 for each month of residence, because Medicaid pays the cost of nursing home care. The $25 is for personal and incidental ex- penses which are not covered by Medicaid. (See p. 3.) Supplemental Security Income overpayments are being made because Social Security often does not know that recipients have been admitted to nursing homes, and payments over $25 continue. In California and Florida such overpayments amounted to $7.6 million during 1975. GAO estimates that the majority of these overpayments could have been prevented through timely reporting of nursing home admissions. (See p. 4.) Social Security regulations make the re- cipient, or the person authorized to accept payments on his or her behalf, responsible for reporting nursing home admissions. GAC's Tear Shee. Upon removal, the report i HRD-77-131 cover date should be noted hereon. study showed hat these individuals reported only 3 percent of admissions. (See p. 6.) Social Security has no regulations for ob- taining information on nursing home admis- sions. In several instances, Social Security district offices, on their own initiative, had made informal arrangements with nursing homes to report admissions. These nursing homes were an effective source for timely reporting when provided frms to report admissions and when frequent visits were made to the homes to encourage prompt re- porting; (See p. 6.) GAO recommends that the Secretary of Health, Education, and Welrare direct the Commis- sioner of the Social Scurity Administration to (1) require the district offices to provide forms to nursing homes for reporting admissions and (2) actively work with the nursing homes to obtain timely reports. GAO also recommends that the Secretary direct the Administrator of the Health Care Financ- ing Administration to have the States estab- lish procedures requiring nursing homes par- ticipating in the Medicaid program to re- port admissions of recipients to district offices promptly. (See p. 10.) she Department of Health, Education, and Welfare enerally concurred with our con- clusions and recommendations. However, the Department commented that nursing homes would report recipient admissions monthly through a State agency rather than directly to Social Security. This procedure would not be acceptable because it would nt re- sult in timely reporting of admissions to Social Security. Timely reporting is cri- tical to minimize overpayments which result from failing to implemen. the reduced pay- ment standard. (See pp. 11 and 4.) ii Contents Page DIGEST i CHAPTER 1 INTRODUCTION 1 SSI program Scope of review 1 2 2 NEED FOP TIMELY REPORTS O ENTERING NURSING OMES RECIPIENTS 3 Entering a nursing home affects payments SSI Overpayments to nursing home 3 residents in 1975 Procedures for reporting nursing 4 home residence 6 Conclusions Recommendations 9 10 3 AGENCY COMMENTS AND OUR EVALUATION 11 APPENDIX I Letter dated May 20, 1977, from Thomas Morris, Inspector General, Department D. Health, Education, and Welfare of 13 II Principal officials of the Department Health, Education, and Welfare of for administering activities responsible this report discussed in 15 ABBREVIATIONS GAO General Accounting Office HEW Department of Health, Education, and Welfare SSA Social Security Administration SSI Supplemental Security Income CHAPTER 1 INTRODUCTION In August 1975 Senator Birch Bayh requested that we examine the Social Security Administration's ment of the Supplemental Security (SSA's) manage- Income (SSI) program to determine wys of reducing SSI overpayments. second report on this subject. 1/ This is our During the period July 1974 through estimates, based on its quality assurance June 1976, SSA paid SS1 recipients about $600 million data, that it over- annually. SSI PROGRAM The Social Security Amendments of 1972 (42 U.S.C. 1381 (Supp. II, 1972)) established the SSI program to replace the Federal grant-in-aid programs, administered which provided assistance to the by the States, aged, blind, or disabled people with limited income and resources. by SSA of the Department of Health, SSI is administered Education, (HEW) and funded by the Federal Government, and Welfare mental benefits paid by the States. except fot supple- is mandatory if Federal payments State supplementation ments previously administered by are less than program pay- the States. Additional supplementation may be provided at the option of the States. In addition to being aged, blind, individual's eligibility for SSI or disabled, an is subject to certain income and resource limitations. For example, more than $1,500 ($2,250 for a couple) an individual with is ineligible. of countable resources Payment amount is dependent on living are generally classified as independent arrangements which in the household of another, and (in own household), current law, an eligible in a nursing home. 2/ Under individual with no countable income and living independently receives a Federal SSI payment of $177.80 a month ($266.70 for a couple). 1/Our first report, entitled "Supplemental Security Income Payment Errors Can Be Reduced," HRD-76-159, was also done at Senator Bayh's Nov. 18, 1976, request. 2/The term nursing home as used in this report refers to a Medicaid (title XIX) skilled nursing facility. or intermediate care On January 1, 1974, SSA began making SSI payments to about 3 million people converted from State and local pro- grams. By December 1976, about 4.2 million people were receiving SSI benefits. In the program's first 3 years, over $13.1 billion in Federal funds and about $3.8 billion of federally administered State supplemental funds were paid to SSI recipients. States administering their own supplemen- tal payments disbursed an additional $467 million during this period. SCOPE OF REVIEW The review was made in California, New York, and FloridP, which account for alut 28 percent of the Nation's SSI reci- pients. We evalutated SSA district office procedures for obtaining reports on SSI recipients who enter nursing homes and the timeliness of such reports. In California and Florida we reviewed SSI and Medicaid paymenLs to nuLsing home residents identified in a random sample of 1975 Medicaid billings. We also drew a random sample of Medicaid billings from New York City and 15 New York State counties for September and October 1975. This information was not useable, however, because of insufficient centralized information on New York's Medicaid program. 2 CHAPTER 2 NEED'FOR TIMELY REPORTS ON RECIPIENTS ENTERING NURSING HOMES In 1975 overpayments of about $7.6 million were made to Supplemental SecurJiy Income recipients in California and Florida because tht 'ocial Security Administration did not know the recipients had been admitted to nursing homes. SSA regulations require the recipient, or his or her authorized representative, to report changes in living arrangements (such as adrttance to a nursing home) but do not establish other methods for obtaining such information. Recipients or their authe izod representatives have proven to be unreliable in repolting such matters. Some SSA district offices in California have requested nursing homes to report when SSI recipients are admitted. Where appropriate contact and followup with the nursing home was made by the district office, more timely information on admittance of SSI recipients was obtained. We believe that procedures should be developed to obtain such reports from nursing homes nationally. ENTERING A NURSING HOME AFFECTS- SSI PAYMENTS The Social Security Act, as amended (42 U.S.C. 1382-- 1382f Supp. V, 1975)), established maximum SSI payment standards based on three living arrangements which are illustrated in the following chart. 3 Payment standard including optional Federal --- State supplementation (note a) Living payment Florida arrangements standard California New York (note-b) Independent $177.80 $276.00 $228.65 $177.80 Household of aniother 118.54 220.07 120.05 118.54 Nursing home 25.00 25.00 25.00 25.00 a/Mandatory supplementation payments are made to some of the recipients who were on the State-administered programs at the time SSI became effective. Such payments are made on a case-by-case basis according to the recipient's benefit level under the former programs. b/Florida pays no optional State supplementation to indivi- duals living independently or in the household of another. As shown above, entering a nursing home has the greatest impac on the SSI payment amount. When a recipient becomes a nursing home resident, his or her payments should be reduced to not more than $25 for each calendar month of residence. The reduced payment standard becomes effective with the re- cipient's first full calendar month of residency in a nursing home. The recipient's benefits are reduced because his room, board, and medical attention are being provided under the Medicaid program; $25 is for personal and incidental expenses. Consequently, if SSA is not promptly notified of a nursing home admission, substantial overpayments result because the recipient's payment is based on a living arrangement other than in a nursing home. OVERPAYMENTS TO-NURSING HOME RESIDENTS IN-T75 To determine the impact of untimely or nonreporting of nursing home admissions, we reviewed SI payments to nursing home patients in California and Florida. In each State we used a random sample from monthly Medicaid bills paid for patients n nursing homes during 1975 and identified those patients who had been issued SSI payments for the same month as the bills. We then determined whether this payment was correct, based on residing in a nursing home. The results of our sample and projected SSI overpayments for the two States are shown below. 4 California Florida Number of 1975 Medicaid billings 765,025 175,137 Billings sampled 581 626 Patients in sample: Receiving SSI 191 104 Overpaid SSI 39 23 SSI overpayment cases as a percentage of: Medicaid billings 6.7 3.7 SSI recipients 20.4 22.1 Average SSI overpayments in the sample month $138.42 $81.13 Projected overpayments for SSI recipients in nursing homes in 1975 $7,100,000 $500,000 Most of the recipients who were overpaid in the billing month were also overpaid in previous or later months while in the nursing home. On the average, recipients were over- paid for about 7 months. While some overpayments are unavoidable due to the time required to stop issuance of recipients' checks, a majority of the projected $7.6 million overpayments for California and Florida could ave been prevented thrugh timely reporting of nursing home admissions. We also used a random sample from New York City and 15 New York State counties for September and October 1975 and found that SSI recipients in nursing homes had been overpaid. However, we were unable to project statewide overpayments because of insufficient centralized information on the State's Medicaid program. We were unable to project nationwide overpayments because possible differences in the percent of the SSI population entering nursing homes, differences in State supplementation levels, and variances in SSA procedures cause the rate of SSI overpayments to nursing home resi- dents to change from State to State. However, SSA esti- mates, based on its quality assurance data for the period January through June 1976, that failure to reduce the pay- rent standard for SSI recipients entering nursing homes ;esults in about $23 million annually in overpayments. 5 PROCEDURES FOR REPORTING NURSING HOME RESIDENCE SSA regulations make the recipient, or the person authorized to accept payments on his or her behalf, respon- sible for reporting changes which affect SSI payment amount or eligibility (20 C.F.R. 416.705). According to SSA pro- cedures, the recipient is to be advised of this responsibility at the time of initial entitlement to benefits and at least once a year thereafter. The regulations do not establish other methods or procedures for obtaining the information. We reviewed nursing home admissions in California, New York, and Florida to determine the effectiveness of recipient reporting and the potential for developing alternate sources of information about recipients entering nursing homes. Two SSA district offices were selected in each State to deter- mine when and how the offices obtained information that SSI recipients had entered nursing homes. Our review included 64 of the 71 nursing homes within the selected district offices' jurisdiction and all SSI recipients admitted to these homes in January 1976 1/ who were still patients on April 30, 1976--a total of 6 recipients. Our sample showed that recipients notified SSA of their admission in only 2 of the 69 cases (3 percent). In 14 of the cases (20 percent), the SSA district office did not know as of May 1, 1976, that the recipient had entered a home. In the remaining 53 cases (77 percent), SSA was informed from another source, as follows: Source Number of-cases Percent Nursing home a/32 46.4 Relatives a/12 17.4 Social worker 6 8.7 Other 3 -4.3 Total 53 76.8 a/Some of these reports may have been made at the recipient's request. l/February 1976 admissions to nursing homes in the jurisdic- tion of one New York district office were included. 6 We also reviewed these 53 cases to determine the timeliness with which the admission reports were submitted. In 15 cases (28 percent), reports were made within a of admission; in 17 cases (32 percent), reports were week made from 33 to 89 days after admission; and the remaining 21 cases (40 percent) were made between 1 week and 33 days. In each district office visited, the procedures obtaining reports on admissions differed. Of the 15 for made within a week of admission, 11 were made to SSA reports dis- trict offices within California. Several SSA district offices in California have requested nursing homes to report the admission of SSI recipients cause recipients generally do not do so. On their be- wn initia- tive, several district offices, together with the Los Angelis County Council of Nursing Home Associations, designed cial form to facilitate this reporting. In the two a spe-. California offices reviewed, this was the procedure followed. Conse- quently, 48 percent of admissions in our sample from district offices were reported by the nursing homes. these The reports were received an average of 6.6 days after admission. In one of the district offices in California, nursing homes were contacted at least twice a month to assure that SSI admissions were reported, as well as seeing to any SSA or SSi benefit problems. Nursing home personnel wereother very aware of the reporting form and the reporting procedures to be followed. In this district office, 71 percent of the admissions were reported by the nursing homes. The longest lapse between admission and the nursing home's report was 16 days. Both SSA district offices reviewed procedures for obtaining information on in New York had admissions of SSI recipients to nursing homes, but neither was as effective as California. Nevertheless, 67 percent of admissions reported to the district offices visited in New York were reported by nursing homes. This information, however, was received an average of 33 days after admission. According to officials of one district office York, their procedure is based upon the fact that in New nursing home personnel know SSI recipients should not receive pay- ments over $25. Consequently, when nursing home personnel become aware of overpayments they inform the SSA field resentatives who visit the larger nursing homes about rep- once a week. Smaller homes, acting for the recipients, the payments through the mail. One problem with thisreturn 7 procedure is that SSA would become aware of an admittance a nursing home only if the recipient's payment is to forwarded to the nursing home from the recipient's previous address. In this district office, information on 80 percent of admis- sions was received through this method. However, informa- tion on 35 percent of admissions was obtained more than 30 days after admission. The managei of the other district office in New York stated that its procedure was based upon field represen- tatives visiting nursing homes to assist in dealing with social security or SSI benefit problems. During these visits the field representatives request nursing homes to send SSA a letter upon admission of SSI recipients. From this proce- dure, information on 40 percent of admissions was received. However, information on only 10 percent of admissions was received within the eek of admission, and 20 percent the admissions reviewed were received over 60 days of after admission. The SSA district offices reviewed in Florida used re- ports on SSI admissions to nursing homes obtained from State welfare workers. However, the nursing homes report the admission of all Medicaid patients to the State welfare workers; this is done so that the worker can authorize Medicaid payments. Although SSA determines Medicaid eligi- bility for Florida SSI recipients, the State redetermines Medicaid eligibility for all Medicaid patients admitted to nursing homes. Florida's Department of Health and Rehabili- tation Services, which administers the State's Medicaid program, requires its welfare workers to notify SSA when a nursing home admission is an SSI recipient. The district offices reviewed in Florida had taken steps to obtain reports on SSI recipient admissions directly from the State's nursing homes. Neither office, however, had given priority to making nursing homes a reporting source. Thirty-eight percent of the admissions sampled were reported by State welfare workers an average of 13 days after admission. In only 6 percent of admissions was information obtaindA from the nursing home. Field representatives from one district office in Florida occasionally visited nursing homes and provided forms for reporting SSI admissions. A district office official said that not enough emphasis had been placed on this system. Several nursing home administrators said that the district office had not given them the forms. 8 We talked with the district office managers and Florida about the potential for using in New York a California, making frequent visits to nursing form as used in ing the homes report admissions. District homes, and hav- agreed that such a system would work well. managers generally pressed, however, that some nursing homes Concern was ex- may not cooperate. In our discussion with California nursing we found no reluctance to cooperate with SSA. home officials, ship and willingness to cooperate with SSA The relation- was extremely good where SSA field representatives made frequent visits to nursing homes, explained the need for information on SSI recipients, and left formis for reporting admissions. The Health Care Financing Administration of ment of Health, Education, and Welfare is the Depart- responsible developing Medicaid program policies, setting for standards, making sure of compliance with Federal legislatior and lations. / The Secretary of HEW, through and regu- Financing Administration, requires nursing the Health Care homes to maintain records and report information for the Medicaid These records contain the information that program. reports on SSI admissions. We believe the SSA would need in Secretary require nursing homes to report the admission should of SSI recipi- ents to SSA. CONCLUSIONS Overpaymen3 are being made because SSA does that SSI recipients have been admitted to not know nursing Recipients or their authorized representatives homes. to be an unreliable source of such information. have proven establish other methods for obtaining timely SSA should on SSI recipients entering nursing homes. information procedures would reduce overpayments in the Improved reporting SSI program. Nursing homes are a good source for reporting pient admissions. Furthermore, they are SSI reci- required to maintain records containing the information SSA would of SSI admissions. There are, however, no need in reports quiring that nursing homes report admissionsregulations re- review showed that nursing homes were the to SSA. Our most effective and reliable source of this information, and can be required to I/On March 8, 1977, the Secretary of HEW announced administrative responsibility for the Medicaid that the program was transferred from the Social and Rehabilitation to a new Health Care Financing Administration. Service 9 report admissions with a minimal amount of effort on their part. Nursing homes were the principal information source in both California and New York. State social workers were a major source in Florida, and hey received their infornation from nursing homes. Nursing homes proved to be an effective source for timely information when the SSA district office provided forms to nursing homes to report admissions and when dis- trict office personnel made frequent visits to the homes to encourage prompt reporting. RECOMMENDATIONS We recommend that the Secretary of HEW: -- Direct the Commissioner of the Social Security Administration to establish procedures requiring that SSA district offices provide forms to nursing homes for their use in reporting admissions and to actively work with the nursing homes to obtain timely reports. -- Direct the Administrator of the Health Care Financing Administration to have the States establish procedures requiring nursing homes participating in the Medicaid program to report the admission of SSI recipients to SSA district offices promptly. 10 CHAPTER 3 AGENCY COMMENTS AND EVALUATION In a letter dated May 20, 1977, HEW expressed agreement with our report and stated that the timeliness and quality of reporting SSI recipient admissions to nursing homes can and should be improved. HEW concurred with our recommendation that SSA should establish procedures requiring that district offices provide forms to nursing homes for their use in reporting admissions and to actively work with the nursing homes to obtain timely reports. SS% has rec-ntly revised a form which will gather infor- mation trom recipients when admitted to or discharged from a nursing home. SSA will supply this form to nursing homes. The mailable forms will be stamped with the address of the local SSA district office. HEW concurred in principle with our recommendation that the Health Care Financing Administration have the States establish procedures requiring nursing homes participating in the Medicaid program to report the admission of SSI recipients to SSA district offices promptly. HEW outlined the procedure to be followed by the nursing homes. First, the States will have the nursing homes report all SSI admissions to the "single State agency." Second, the "single State agency" will report such information monthly to the SSI regional office. We are not sure what HEW intended by this procedure. Our recommendations were aimed at a single objective, that is, to have SSA district offices supply nursing homes with forms which the nursing homes could use to report SSI reci- pient admissions to district offices. Our first recommenda- tion intended that SSA prepare and distribute the required form through its district offices. Since SSA has no respon- siblity for nursing home action, our second recommendation was that the Health Care Financing Administration require the nursing homes to use the form. The procedure outlired by HEW could be interpreted as having nursing homes report SSI recipient admissions directly to the "single State agency" and SSA district offices through use of the self-addressed form. This dual reporting system is not what we intended, and we fail to see that it has any real benefit, unless such information is for some reason 11 useful to the "single State agency." We would not object this dual reporting if it did not delay reporting to to the district offices. The procedure outlined by HEW could also be interpreted as having nursing homes only report SSI recipient admissions to the "single State agency," that is, nursing homes would report admissions directly to district offices. We would not find this procedure unacceptable. As our report illustrates, timely reporting of SSI reci- pient admissions to district offices is critical to minimizing the amount of overpayments which result from failing to imple- ment the reduced payment standard. Due to the time required to stop issuance of recipients' checks, some overpayments unavoidable. The majority of overpayments can be avoided, are however, if SSA is apprised of admissions as early as possible. The procedure outlined by HEW for reporting admissions only monthly would probably result in at least one month's overpayment in every case. In addition, it would make reporting admissions more untimely in those areas where, pointed out in the report (see p. 7), district offices as and nursing homes have reached agreements on their own, which provide that nursing homes report admissions directly to district offices. We believe HEW should implement the procedure according to our recommendations and require that nursing homes report SSI recipient admissions directly to SSA district offices. We believe this procedure is the most effective and simplest means for reducing the number of SSI overpayments which result from failing to implement the reduced payment standard. 12 APPENDIX I APPENDIX I 0 0". DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE OFFICE OF THE SECRETARY WASHINGTON, D.C. 2a0l MAY 2 03971 Mr. Gregory J. Ahart Director, Human Resources Division United States General Accounting Office Washington, D.C. 20548 Dear Mr. Ahart: The Secretary asked that I respond to your request for our on your draft report entitled, "Supplemental Security Incomecomments payments to Medicaid Nursing Home Residents Can e Reduced." Over- enclosed comments respresent the tentative position The of the ment and are subject to reevaluation when the final version Depart- of this report is received. We appreciate the opportunity to comment on this draft report its publication. before Sincerely yours, Thomas D. Morris Inspector General Enclosure 13 APPENDIX I APPENDIX I COMMENTS OF THE DEPARTMENT OF HEAI.TH, EDUCATION, AND WELFARE ON THE GAO DRAFT REPORT ENTITLED, "SUPPLEMENTAL SECURITY OVEKPAYMENTS TO MEDICAID NURSING HOME RESIDENTS CAN BE REDUCED," DATED MARCH 11, 1977 GAO Recommendation That the Social Security Administration establish procedures requiring its district offices to provide forms to nursing homes for their use in reporting admissions, and to actively work with the nursing homes to obtain timely reports. Department Comment We concur with this recommendation and are in ':eamentwith the GAO that the timeliness and quality of reporting infor, ,n can end should be improved. Form SSA-8150, "Repecting Events--SSI," recently revised and now being printed, provides or the reporting of any evert affecting eligibility or payments and contains specific questions concerning admissions to and discharges froi nursing homes and other institutions. This form covers a wider range o circumstances than the model form included in GAO's report and, thus, should be more effective as an information gathering mechanism. The district offices will be requ.red to supply these forms with instructions for completing them to institutions in their service areas. The use of this form on a national basis together with the instruction and training to be provided to district and Regional office personnel should lead to significant improvement in quality and timeliness of reporting. GAO Recommendation That the Secretary, HEW, direct the Administrator of the Health Care Financing Administration (HCFA) to have the States establish procedures requiring nursing homes participating in the Medicaid program to report the admission of Supplemental Security Income (SSI) recipients to the Social Security Administration district offices in a timely manner. Department Comment We concur in principle wit. the GAO recommendation and will require the States under the provisions of 45 CF! 250.21 to have all nursing homes participating in the Medicaid program report 11l SSI admissions to the single State agency. Under the provisions of 45 CFR 205.60(a)(2), HCFA will require the single State agency to report monthly such information to the SSI Regional Office. 14 APPENDIX II APPENDIX II PRINCIPAL OFFICIALS OF-THEDEPARTMENT OF HEALTH-EDUCATION -AND WELFARE RESPONSIBLE FOR-ADMINISTERING ACTIVITIES-DISCUSSED-IN THIS -REPORT --Tenure of office-- From To SECRETARY OF HEALTH, EDUCATION, AND WELFARE: Joseph A. Califano, Jr. Jan. 1977 Present David Mathews Aug. 1975 Jan. 1977 Caspar W. Weinberger Feb. 1973 Aug. 1975 COMMISSIONER OF SOCIAL SECURITY: James B. Cardwell Sept. 1973 Present ADMINISTRATOR, HEALTH CARE FINANCING ADMINISTRATION: Don I. Wortman (acting) Mar. 1977 Present ADMINISTRATOR, SOCIAL AND REHABILITATION SERVICE: Don I. Wortman (acting) Jan. 1977 a/Mar. 1977 Robert Fulton June 1976 Jan. 1977 Don I. Wortman (acting) Jan. 1976 June 1976 John A. Svahn (acting) June 1975 Jan. 1976 James S. Dwight, Jr. June 1973 June 1975 a/The administrative responsibility for the Medicaid program was transferred from the Social and Rehabilitation Service to a new Health Care Financing Administration on March 8, 1977. 15
Supplemental Security Income Overpayments to Medicaid Nursing Home Residents Can Be Reduced
Published by the Government Accountability Office on 1977-08-23.
Below is a raw (and likely hideous) rendition of the original report. (PDF)