U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.


The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Missouri's Determination of Medicaid Disproportionate Share Hospital Eligibility for State-Owned Institutions for Mental Diseases," (A-07-06-03086)

December 13, 2007

PDF File Complete Text of Report is available in PDF format (850 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


Our objective was to determine whether the Missouri Department of Social Services (the State) correctly determined State-owned Institutions for Mental Diseases (IMD) to be eligible for Medicaid disproportionate share hospital (DSH) payments for Federal fiscal years (FFY) 20032005. 

The State correctly determined seven State-owned IMDs to be DSH eligible for FFYs 20032005.  However, the State incorrectly computed the Medicaid Inpatient Utilization Rates (MIUR) for the IMDs because it did not comply with Federal regulations concerning the exclusion of inpatient days related to unallowable age groups and incarcerated individuals.  In addition, the State included unallowable inpatient days related to accounting errors for the FFY 20032005 DSH eligibility determination.  The State also lacked adequate controls concerning the acquisition, review and maintenance of contemporaneous documentation to support the MIUR calculations.  As a result, the State could not adequately support its MIUR calculations for State-owned IMDs.  These errors did not cause the MIUR to fall below the 1-percent threshold at any of these State-owned IMDs.  However, we are concerned that the State may in the future overstate the MIURs and, consequently, incorrectly classify one or more IMDs as DSH eligible.

We recommend that the State (1) comply with Federal regulations concerning the exclusion of unallowable inpatient days from the MIUR calculations; and (2) strengthen controls to eliminate accounting errors and to acquire, review, and maintain contemporaneous documentation to support the original Medicaid DSH MIUR calculations.  The State neither agreed nor disagreed with our first recommendation and agreed with our second recommendation.