The Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) to help improve the quality of care of home and community-based services (HCBS) provided to Medicaid beneficiaries. CDIA has commented to CMS before, in connection with long-term care, and we will again convey to CMS the importance of name-based criminal background checks.

The RFI notes that “[p]ersonal care services (PCS), are a critical component of HCBS, and there is evidence of program integrity vulnerabilities in their provision.” Yet, an OIG investigative advisory has identified fraud in the provision of PCS.  The fraud cited in the OIG report focused mainly on fraud against the government in billing for PCS that did not occur.  The OIG “investigative advisory is part of new work that OIG is conducting to examine vulnerabilities in the PCS program related to billing, payment fraud, and patient safety.” The RFI points out that CMS has

not required states to adopt a standardized set of minimum qualifications for PCS attendants. Currently, some states require PCS attendants to enroll in Medicaid as providers, including undergoing a criminal background check, and assign each attendant a unique provider number. However, many states do not have such procedures in place, and we have not issued minimum Federal qualifications for PCS attendants. OIG has strongly encouraged CMS to undertake actions establishing minimum federal qualifications and screening standards for PCS attendants, including background checks; and require states to enroll or register all PCS attendants and assign them unique numbers for purposes of tracking claims.

The RFI seeks input on whether there should be national qualifications for PCS attendants.  A key question asked, and the focus of the CDIA comment, is on “[w]hat issues should be considered in requiring criminal background checks? In the states that are utilizing fingerprinting and background checks already, what lessons can be learned from implementation and experience with these approaches?”