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Review of Timeliness of West Virginia's Retroactive Claims for Medicaid School-Based Services

The State did not fully comply with Federal requirements for an exemption to the 2-year limit for filing retroactive claims for Medicaid school-based services. A portion of the State's retroactive claim, $4.1 million (Federal share), fell outside the required 2-year filing period because it related to expenditures made by the State in quarters ending December 31, 2000, through June 30, 2001. Of this amount, $2.3 million (Federal share) related to new cost components that were not in the original rates used to calculate the claims for school-based services and did not reflect the settlement of previously identified costs. As a result, the $2.3 million (Federal share) was not exempt from the 2-year time limit and was therefore unallowable. The remaining $1.8 million (Federal share) met the requirements for an exemption because it reflected the settlement of previously identified salary and fringe benefit costs.

We recommended that the State refund $2.3 million (Federal share) for costs claimed after the 2-year filing limit that were not exempt and ensure that future claims comply with the 2-year filing limit. In written comments on our draft report, the State did not concur with our finding and recommendation. However, nothing in the State's comments gave us cause to modify our recommendation.

Filed under: Center for Medicare and Medicaid Services