Corporate Compliance

Gov't audit insider: Medicaid payments for school-based services

Healthcare Auditing Weekly, September 16, 2003

The OIG performed this audit to determine whether costs claimed for school-based health services by the Massachusetts Division of Medical Assistance (DMA) were reasonable, allowable, and adequately supported in accordance with the terms of the state Medicaid plan and applicable federal regulations.

The OIG took the following steps to reach its objectives:

1. Reviewed federal and state laws, regulations, and guidelines pertaining to the Medicaid program and special education related to school-based health services. The OIG also reviewed the Commonwealth of Massachusetts' state plan amendment 92-14 that describes the Department of Public Welfare's (now DMA) procedure for reimbursing school-based special needs services.

2. Reviewed the Interdepartmental Service Agreement between the DMA and the University of Massachusetts (UMass) that outlined UMass' responsibilities to provide administrative, management, and technical support to the DMA in administering the state Medicaid plan.

3. Reviewed eight Massachusetts local education agencies (LEA) to determine whether the costs the LEAs claimed for school-based health services through the Commonwealth of Massachusetts were reasonable, allowable, and adequately supported in accordance with the terms of the state Medicaid plan and applicable Federal regulations.

4. Issued individual reports to all eight LEAs.

5. Identified all individual claims made for days when the schools were not in session. The OIG did this by visiting the LEAs who received reports.

6. Selected from the eight LEAs a population of 140,656 recipient/months with claims totaling $19,828,368 (federal share). Also selected a simple random sample of 100 recipient/months from each school district (total 800 recipient/months) representing claims totaling a federal share of $103,448 in Medicaid claims paid during the audit period for school-based health services.

7. Held discussions with officials from the Centers for Medicare and Medicaid Services, the DMA, UMass, each of the eight LEAs, and several out-of-district schools.

Click here to read the OIG audit report "Medicaid Payments for School-Based Health Services - Massachusetts Division of Medical Assistance - July 1999 Through June 2000."

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