Gov’t audit insider: Medicaid behavioral health
Healthcare Auditing Weekly, December 16, 2003
The Office of Inspector General's (OIG) objectives for this audit were to determine (1) to what extent intergovernmental transfers or other financing mechanisms are used to maximize federal Medicaid reimbursement, (2) whether the contract procurement process conforms to federal regulations, and (3) whether the profits or losses incurred by counties in administering the program are reasonable.
The OIG took the following steps for this audit:
1. Reviewed county-specific revenue and expense records for state fiscal years 2001 and 2002 and proposed capitation calendar rates for calendar year 2003.
2. Reconciled country reported capitation payments with the amounts Pennsylvania claimed on Form CMS-64.
3. Reviewed the HealthChoices waiver, Pennsylvania's Medicaid state plan, federal statutes and regulations, and CMS' implementing policies and guidelines.
Click here to read the audit report "Review of the Commonwealth of Pennsylvania's Medicaid Behavioral HealthChoices Program."
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