Review of New Mexico Medicaid Personal Care Services Provided by Coordinated Home Health.

摘要

The State agency contracts with a third-party assessor to perform an in-home assessment of each recipient that determines the types and amounts of care needed and to develop a personal care services plan. In addition, New Mexico law requires a supervisor from the personal care services provider agency to visit each recipient or his/her personal representative in the recipients home monthly. The State agency periodically reviews provider agencies to ensure compliance with Federal and State requirements. The State agency reported to CMS personal care services expenditures of approximately $433 million ($309 million Federal share) from October 1, 2006, through September 30, 2008. Of that amount, Coordinated Home Health (Coordinated), a personal care services provider in Las Cruces, New Mexico, received $37,676,105 ($26,931,344 Federal share). Our objective was to determine whether the State agency ensured that Coordinateds claims for reimbursement of Medicaid personal care services complied with certain Federal and State requirements.