Series: Utilization and Oversight of Medicare Part C In-Home Support Services

OBJECTIVE

Medicare Advantage (MA) plans may offer supplemental benefits not covered under Original Medicare to its enrollees. MA organizations must design the supplemental benefits to improve enrollees’ health, allow enrollees to manage their chronic conditions, or support enrollees’ access to care. During the past 5 years, CMS has expanded the flexibility of the types of supplemental benefits that can be provided, including in-home support services (IHSS). Given the new CMS reporting requirements, there is a need to assess whether MA organizations are accurately capturing and reporting IHSS utilization data. In addition, because CMS does not require MA organizations to conduct background checks on non-health care professionals, we will also determine what kind of background checks, if any, that MA organizations conducted. Without effective oversight, there is a risk that services are not being delivered as intended, leading to discrepancies in encounter data, potential gaps in care, and financial inefficiencies. For this series of audits, we will determine whether MA organizations complied with Federal requirements for IHSS being used by their enrollees.

There are 3 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (3)

TIMELINE

• July 3, 2025
  Series Number SRS-A-25-035 Assigned
• July 3, 2025
  Project Announced

  Project OAS-25-06-087

• October 1, 2025
  Project Announced

  Project OAS-25-06-153

• October 28, 2025
  Project Announced

  Project OAS-26-06-011

• Today
  3 Audits In-Progress
• Est FY2027
  Estimated Fiscal Year for Series Completion

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