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

CMS could not rely on New Jersey's qualification requirements to ensure quality of care and that adequate protection was provided to Medicaid beneficiaries receiving home health services. On the basis of our sample results, we estimated that home health workers did not meet qualification requirements for 73,260 of the 289,185 claims covered by our review and that the Federal Government reimbursed New Jersey $4 million for these services during our audit period (January 1, 2007, through July 31, 2008).

Specifically, we found that some home health agencies (HHAs) did not meet certain State requirements for HHA workers. Of the 150 claims in our sample, HHA workers associated with 112 claims met Federal and State qualification requirements; however, workers associated with the remaining 38 claims did not. Of the 38 noncompliant claims, 12 contained more than 1 deficiency.

To improve protection provided to Medicaid beneficiaries receiving home health services, we recommended that CMS (1) work with the Department of Human Services (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 stated that they would not be providing comments to our report but rather would respond to CMS after we issued the final report. CMS concurred with our recommendations.