Medicaid: New Mexico Did a Terrible Job Vetting Medical Employees
A state’s Medicaid program provides medical assistance to low-income individuals and those with disabilities under Title XIX of the Social Security Act. The state and federal governments jointly fund the program, but New Mexico has to adhere to federal requirements. Federal audits are standard to ensure compliance with federal and state requirements, especially if the state has a record of failing to comply with those requirements.
A Problematic History
HHS audited New Mexico’s Medicaid PCS program because the state has a history of not adhering to requirements regarding the qualifications of individuals hired to be PCS attendants, the press release details. Past audits determined that attendants did not have TB testing, CPR and first aid training and lacked continued education or annual training.
Current Audit Results
During the audit conducted for the 2019 calendar year, HHS took a random 300-claim sample out of 2,696,049 paid Medicaid PCS encounter claims. About 200 claims were taken from providers in previous audits and 100 from other PCS providers in New Mexico. HHS looked at whether or not the individual providing the associated services had qualifications that complied with state and federal requirements.
They found that New Mexico did not adequately ensure that PCS attendants had the needed qualifications, according to the Report in Brief. Only 106 claims of the 300 claims sampled had qualified attendants who met the standards of the State and Federal requirements. The remaining 194 claims had attendants that were missing one or more federal or state requirements.
Auditors checked for requirements relating to CPR and first aid certifications, written competency tests, annual training, TB testing, background checks and abuse registry checks, according to the brief report. The audit estimated that 69 percent of attendants during the 2019 audit period did not have adequate qualifications to meet the requirements.
HHS found in the full report that in 34 of the 300 sampled claims, the attendants were not given a criminal background check before they started providing services. They also noted that one of the 34 attendants failed their background seven months after providing the service in the claim. The company the attendant worked for confirmed that they fired the attendant after the results came in, but that doesn’t lessen the risks the unvetted attendant posed to Medicare recipients.
Like the background checks, TB testing was not conducted on 36 of the 300 sample claims before they began working as attendees. About 23 percent of attendants were not determined to be TB negative through a blood test and chest x-ray, which put Medicaid enrollees in danger of catching the infectious disease.
The State of New Mexico Concurs
In its official response, the State of New Mexico agreed with all HHS recommendations. They said they revised their Medicaid Managed Care Policy Manual, amended their provider contracts to include annual audits and will take action against providers that do not ensure their attendants comply with all state and federal qualification requirements according to the full report.
They also plan to create and issue an annual newsletter about the significance of attendant qualifications.
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