The OIG has issued a report that assesses state oversight of services provided through 1915(c) home and community-based services (HCBS) waiver programs.  According to the OIG, seven of the 25 states reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries through these waiver programs.  Moreover, while CMS renewed the waiver programs in all seven states, three did not adequately correct identified problems before or after renewal of their programs.  The OIG recommends that CMS:  provide additional guidance to states; require states that do not meet certain standards (called “assurances”) to develop corrective action plans; require on-site visits prior to waiver renewals; develop a broader array of approaches to ensure compliance with assurances; and make information about state compliance with assurances available to the public.  CMS partially concurred with the recommendations.   In a separate report, the GAO reviewed how states have implemented HCBS programs, including HCBS options under the ACA.  The GAO included a discussion of the factors states consider in deciding whether to pursue ACA options, including potential effects on state budgets, staff availability, and interaction with existing state Medicaid efforts, including broader Medicaid reform plans.  The GAO notes that its findings “underscore the importance of ongoing federal technical assistance to help states navigate various HCBS options as they seek to ensure appropriate availability of HCBS.”