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Review of New Mexico Medicaid MCO PCS

Announced on  | Last Modified on  | Project Number: A-06-22-02000
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Personal care services (PCS) is a Medicaid benefit for the elderly, people with disabilities, and people with chronic or temporary conditions. It assists them with activities of daily living and helps them remain in their homes and communities. Examples of PCS include bathing, dressing, light housework, money management, meal preparation, and transportation. Prior OIG reviews identified significant problems with States' compliance with PCS requirements. Some reviews also showed that program safeguards intended to ensure medical necessity, patient safety, and quality, and prevent improper payments were often ineffective. We will determine whether improvements have been made to the oversight and monitoring of PCS and whether those improvements have reduced the number of PCS claims not in compliance with Federal and State requirements.

TIMELINE

REPORT PUBLISHED

New Mexico Did Not Ensure Attendants Were Qualified To Provide Personal Care Services, Putting Medicaid Enrollees at Risk (A-06-22-02000)

24-A-06-101.01 to CMS - Closed Implemented
Closed on 09/30/2025
We recommend that the New Mexico Human Services Department work with the MCOs todevelop procedures to monitor PCS provider compliance with attendant qualifications, including those related to criminal background checks, abuse registry checks, TB tests, initial written competency tests, annual training, and CPR and first aid certifications; educate providers more frequently through methods such as guidance letters or webinars to increase PCS providers' understanding of attendant qualification requirements; and take corrective action against providers that do not ensure that attendants comply with qualification requirements, which could include removing providers that repeatedly fail to comply with the State's PCS program.

24-A-06-101.02 to CMS - Closed Implemented
Closed on 09/30/2025
We recommend that the New Mexico Human Services Department share the results of our audit report with PCS providers statewide to emphasize the importance of attendants meeting qualification requirements and clarify the oversight provisions in its contracts with MCOs to require MCOs to monitor PCS providers' compliance with attendant qualification requirements and report monitoring results to the State agency.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Managed Care
Target Groups
-
Financial Groups
Medicaid