An unimplemented recommendation that the Centers for Medicare & Medicaid Services require states to either enroll Medicaid personal care services attendants as providers or require the attendants to register with their state Medicaid agencies and be assigned a unique identifier occupies the No. 14 spot on a new list 25 unimplemented recommendations that “would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented,” according to a report released Monday by the U.S. Department of Health and Human Services Office of Inspector General.

Personal care services, according to the OIG, are subject to “persistent fraud and beneficiary harm.” The OIG also said it has concerns about the varying standards for, and in some cases minimal vetting of, personal care services attendants. The services support activities of daily living for people living in traditional homes as well as assisted living communities and other group settings.

CMS continues to deliberate on the feasibility of requiring unique identifiers for attendants and reflecting their identity on personal care services claims, according to the report. Also, the Cures Act mandated that states implement an electronic visit verification system for all Medicaid personal care services by Jan. 1, 2020, the OIG noted.

OIG reports relevant to the recommendation, the office said, were issued in November 2012 and December 2017.

Appendices in the annual report, which is titled “Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: OIG’s Top Recommendations,” also mention recommendations related to long-term care background checks and assisted living hospice care.

The OIG classified as a “significant unimplemented recommendation” its January 2016 exhortation that CMS continue working with participating states to fully implement their background check programs for providers of personal care services, residential care providers and other long-term care providers.

The OIG’s January 2015 recommendation that CMS find a way to decrease incentives that make it attractive for hospices to seek assisted living residents who have certain diagnoses or are likely to have long stays; develop and adopt claims-based measures of quality; and make hospice data publicly available for beneficiaries has been superseded by recommendations made in a July 2018 report, according to the report.