Report Materials
Why OIG Did This Audit
Prior Office of Inspector General (OIG) audits of New Mexico’s Medicaid personal care services (PCS) program found that the New Mexico Human Services Department (State agency) did not always ensure that PCS were provided by an individual (attendant) qualified to provide such services in accordance with Federal and State requirements. The audits identified several deficiencies related to attendants’ qualifications, including areas related to tuberculosis (TB) testing, annual training, and certifications in cardiopulmonary resuscitation (CPR) and first aid.
Our objective was to determine whether the State agency ensured that PCS were provided by qualified attendants in accordance with Federal and State requirements.
How OIG Did This Audit
Our audit covered 2.7 million paid Medicaid PCS encounter claims (claims) and the qualifications of the attendants who provided those services during CY 2019 (audit period). We reviewed a stratified random sample of 300 claims to determine whether the associated services were provided by attendants whose qualifications complied with Federal and State requirements.
What OIG Found
New Mexico did not ensure that PCS were provided by qualified attendants in accordance with Federal and State requirements. For 106 of the 300 sampled claims, the associated attendants met qualification requirements. However, for the remaining 194 claims, the associated attendants did not meet 1 or more requirements related to criminal background checks, abuse registry checks, TB testing, written competency tests, annual training, and CPR and first aid certifications.
On the basis of our sample results, we estimate that 69 percent of attendants associated with PCS claims during our audit period did not meet qualification requirements.
What OIG Recommends
We made a series of recommendations to New Mexico, including that it work with Medicaid managed care organizations to develop procedures to monitor PCS providers’ compliance with attendant qualification requirements and to educate providers about these requirements. The full recommendations are in the report.
New Mexico concurred with all of our recommendations and described corrective actions it had taken or planned to take to address them.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.