HHS-OIG Audit Finds Deficiencies in New Mexico’s Medicaid Personal Care Services Program
The Department of Health and Human Services Office of Inspector General (HHS-OIG) conducted an audit of New Mexico’s state Medicaid agency’s personal care services (PCS) program and found that it did not always ensure that PCS were provided by appropriately qualified personnel, which put Medicaid enrollees at risk.
The audit of the New Mexico Human Services Department, New Mexico’s state Medicaid agency, covered 2.7 million paid Medicaid PCS encounter claims in calendar year 2019, from which a stratified random sample of 300 claims was selected for the audit. HHS-OIG assessed the qualifications of the attendants who provided services for those claims. HHS-OIG identified 294 unique attendants associated with the 300 sampled claims.
The attendants for just over one-third (106) of the sampled claims met federal and state qualification requirements; however, the attendants for almost two-thirds (194) of the claims did not meet one or more of the requirements in areas such as criminal background checks, abuse registry checks, TB testing, written competency tests, annual training, and CPR and first aid certifications. Based on the findings of the audit, HHS-OIG estimated that 69% of attendants associated with PCS claims during the audit period did not meet federal and state qualification requirements.
The most commonly identified areas of failure were the requirement to have at least 12 hours of annual training (123 deficiencies), the lack of an initial written competency test (119 deficiencies), no abuse registry check prior to hiring (59 deficiencies), no current first aid training certificate (58 deficiencies), and no current cardiopulmonary resuscitation certification (46 deficiencies).
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According to state agency officials, the reason for the deficiencies was because the state agency relied on managed care organizations (MCOs) to provide oversight of the Medicaid program and the contracts with the MCOs did not include specific provisions related to PCS attendant qualifications. Further, the MCOs lacked procedures to monitor attendants’ qualifications.
HHS-OIG recommended that the state agency develop procedures to monitor PCS provider compliance with attendant qualifications, educate providers more frequently through guidance letters, webinars, and other means to ensure they understand the attendant qualification requirements, take corrective action against providers who do not ensure that attendants qualify with the qualification requirements, and clarify the oversight provisions in its contracts with MCOs and ensure that they require MCOs to monitor PCS providers’ compliance with attendant qualification requirements and report monitoring results to the state agency. The state agency concurred with all HHS-OIG recommendations and provided a plan for implementing them.
