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CMS's Reliance on New York Qualification Requirements Could Not Ensure the Quality of Care Provided to Medicaid Beneficiaries Receiving Home Health Services

CMS could not rely on New York's qualification requirements to ensure quality of care and that adequate protection was provided to Medicaid beneficiaries receiving home health services. Specifically, we found that some home health agencies (HHAs) did not meet certain State requirements for employee health screenings and training.

Of the 150 claims in our sample, HHA workers associated with 135 claims met Federal and State qualification requirements; however, workers associated with the remaining 15 claims did not. On the basis of our sample results, we estimated that 572,089 of the 5,720,894 claims covered by our review, resulting in $27.9 million in Federal Medicaid reimbursement, were associated with HHA workers who did not meet selected Federal and State requirements during our audit period.

To improve protection provided to Medicaid beneficiaries receiving home health services, we recommended that CMS (1) work with the Department of Health (State agency) to reinforce guidance to HHAs regarding worker qualification requirements and (2) direct the State agency to improve its monitoring of HHAs to ensure compliance with worker qualification requirements. State agency officials described the actions they were taking to meet our recommendations, and CMS concurred with our recommendations.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201