Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Quality Assurance


  • Build in an adequate quality assurance system from the outset. Start with a well-defined idea of what the service package will be and what quality outcomes are expected.

  • Assure that the state's regulatory agency subscribes to the planned service philosophy.

  • Recognize that different licensing and regulatory provisions may be needed to serve the Medicaid population, particularly those who meet the criteria for a nursing home level of care.

  • Special training requirements and other rules may be needed for facilities that market themselves as special care units for people with dementia.

  • Residential care settings providing services to waiver clients need to be surveyed on a regular basis with a similar but different focus than nursing homes. Residential care needs a different model of quality, one focused on protection, service needs being met, and livability.

  • Provide flexible oversight and quality improvement activities that are designed to take more of a teaching role rather than an inspection and sanction role.

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