New Jersey Did Not Ensure That Some Medicaid Personal Care Assistant Services Provided Under the Personal Preference Program Met Federal and State Requirements
Learn how the AI-generated research projects were createdOverall Conclusion
New Jersey did not ensure that the State agency adequately monitored and ensured compliance by its MCOs and fiscal intermediary with Federal and State requirements for PPP PCA services; as a result, the program was vulnerable to misuse of Federal funds and the health and safety of PPP participants may have been placed at risk.
Source Document
Audit Scope
Audit covered 387,526 Medicaid ABD participant-months (CY 2019–2021) with 150 participant-months sampled; reviewed MCO and fiscal intermediary documentation to verify compliance with PCA assessments, monthly budgets, cash plans, caregiver verification, and OIG LEIE verifications; estimated noncompliant payments.
Key Findings Summary
The State agency did not ensure that its contracted MCOs and fiscal intermediary complied with Federal and State requirements for providing PCA services to selected PPP participants.
MCOs did not meet PCA assessment and monthly budget amount requirements for 24 of the 150 sampled participant-months.
The fiscal intermediary did not meet cash plan and caregiver verification requirements for 55 of the 150 sampled participant-months.
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AI-Assisted
AI Scope Summary
The audit assessed whether New Jersey's Department of Human Services ensured that contracted Managed Care Organizations and the fiscal intermediary complied with Federal and State PCA requirements for the Personal Preference Program (PPP) for selected ABD participants during CY 2019–2021, using a stratified sample of 150 participant-months from a frame of 387,526; findings showed 41% noncompliant payments totaling about $196.6 million, prompting recommendations to strengthen oversight, documentation, and verification processes for PCA services.
AI-Generated Insight
The audit highlights oversight gaps in a consumer-directed care model, showing that without robust monitoring and documentation controls, significant noncompliance can lead to substantial improper payments and potential risks to participant health and safety.
Audit Objectives
Determine whether the New Jersey Department of Human Services ensured that its contracted managed care organizations and fiscal intermediary complied with Federal and State requirements for providing personal care assistant services to selected Personal Preference Program participants.
Audit Findings (5)
The State agency did not ensure that its contracted MCOs and fiscal intermediary complied with Federal and State requirements for providing PCA services to selected PPP participants.
MCOs did not meet PCA assessment and monthly budget amount requirements for 24 of the 150 sampled participant-months.
The fiscal intermediary did not meet cash plan and caregiver verification requirements for 55 of the 150 sampled participant-months.
On the basis of the sample results, the audit estimated that for 41 percent of participant-months during the audit period, MCOs paid caregivers through the fiscal intermediary for PCA services provided under the PPP that did not comply with Federal and State requirements, totaling approximately $196,584,979.
These deficiencies occurred because the State agency did not adequately monitor the MCOs and fiscal intermediary, leaving the program vulnerable to misuse of Federal funds and potentially placing PPP participants health and safety at risk.
Recommendations (2)
Require MCOs to revise procedures to (1) maintain PCA assessments, (2) complete PCA reassessments annually, (3) maintain monthly budget amounts, and (4) update monthly budget amounts in accordance with applicable PCA assessments.
Require the fiscal intermediary to revise procedures to (1) document participants' cash plans, (2) populate accurate information on cash plans, (3) document all services to be provided in participants' cash plans, and (4) complete and document OIG LEIE verifications for caregivers.