Review of Medicaid Payments for Services Provided Under New Jersey's Section 1915(c) Community Care Waiver by Bancroft NeuroHealth From January 1, 2005, Through December 31, 2007
Based on our sample results, we estimated that New Jersey (the State) improperly claimed approximately $2.7 million in Federal Medicaid reimbursement for Community Care Waiver (CCW) program services provided by Bancroft NeuroHealth (Bancroft) that did not comply with certain Federal and State requirements during calendar years 2005 through 2007. The CCW program allows States to claim Medicaid reimbursement for home and community-based services provided to mentally retarded or developmentally disabled individuals who would otherwise require institutionalization in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).
The claims for unallowable services were made because (1) Bancroft and the State's Division of Developmental Disabilities (the division) did not ensure that they only claimed for documented, allowable CCW program services; (2) the division did not ensure that CCW program services were provided only to beneficiaries with completed and approved individual habilitation plans; and (3) the division did not ensure and document that all beneficiaries were assessed and certified to require an ICF/MR level of care.
We recommended that the State (1) refund $2.7 million to the Federal Government; (2) require Bancroft and the division to ensure that they only claim for documented, allowable CCW program services; (3) require the division to ensure that CCW program services are provided only to beneficiaries for whom there is a completed and approved individual habilitation plan; and (4) require the division to ensure and document that all CCW program beneficiaries approved for services have been assessed and certified to need an ICF/MR level of care. The State partly agreed and partly disagreed with our recommendations.
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