Office of the Legislative Auditor - Financial Audit Division

Report Summary
Managed Care Organizations: Personal Care Assistance Services Encounter Data and Oversight
Performance Audit

The Department of Human Services (DHS) is responsible for overseeing Minnesota’s Medical Assistance program. The department contracts with managed care organizations (MCOs) to provide certain administrative functions and services to program participants, such as personal care assistance (PCA) services. PCA services help recipients with disabilities, chronic diseases, or mental illness live independently in their homes by providing assistance with essential tasks. To manage PCA services under these programs, MCOs work with provider agencies. Provider agencies employ personal care assistants (PCAs) to provide the services.

The Office of the Legislative Auditor (OLA) audited the seven MCOs that managed the delivery of PCA services to determine their compliance with key legal and contract requirements regarding (1) reporting of PCA services encounter claims data, (2) oversight of PCA providers and services, and (3) program integrity.¹ Our audit scope focused on DHS contracts and payments to provider agencies reported to DHS by the MCOs from April 1, 2020, through March 31, 2021.

Conclusion

Although the MCOs generally complied with the selected legal and DHS contract requirements we tested, we identified a number of instances of noncompliance. The more significant instances of noncompliance were in the areas of reporting of encounter data, and provider and service oversight. Additionally, we found instances of DHS noncompliance in the area of provider oversight. The list of findings below and the full report provide more information about these concerns.

Findings

• Finding 1. Blue Plus did not always comply with Department of Human Services contract requirements to accurately submit encounter data. (p. 9)

• Finding 2. The Department of Human Services did not always comply with federal and state laws to revalidate provider agencies and personal care assistants. (p. 12)

• Finding 3. The Department of Human Services and five managed care organizations (Blue Plus, HealthPartners, Medica Health Plans, PrimeWest Health, and UCare Minnesota) allowed personal care assistants to provide services for more than the maximum allowed monthly hours. The five managed care organizations paid some personal care assistants for more than the maximum allowed monthly hours. (p. 13)

• Finding 4. Provider agencies, along with HealthPartners, Medica Health Plans, South Country Health Alliance, and UCare Minnesota, did not always ensure personal care assistants received the required qualified professional supervision. (p. 16)

• Finding 5. Provider agencies, along with the managed care organizations, did not always ensure that personal care assistant timesheets were in compliance with state statutes. (p. 18)

• Finding 6. Medica Health Plans and UCare Minnesota did not always limit the amount of personal care assistance services recipients received, as required by law. (p. 20)

¹ The seven MCOs are Blue Plus, HealthPartners, Itasca Medical Care, Medica Health Plans, PrimeWest Health, South Country Health Alliance, and UCare Minnesota. Encounter data are individual electronic records that document each recipient’s PCA visit.