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Missouri Claimed Federal Reimbursement for Unallowable Personal Care Services Claims

On the basis of our sample results, we estimated that the Missouri Department of Social Services (State agency) claimed $26.7 million (Federal share) in reimbursement for Medicaid personal care services that did not comply with Federal and State requirements. In addition, the State agency claimed $213,000 (Federal share) for personal care services that were not supported by the claim data because the State agency did not have procedures to maintain that supporting documentation. Personal care services may be provided to individuals who are not inpatients at a hospital or residents of a nursing facility, an Intermediate Care Facility for Individuals with Intellectual Disabilities, or an Institution for Mental Diseases. Examples of personal care services include, but are not limited to, meal preparation, shopping, grooming, and bathing.

Of the 100 grouped line items in our sample, 50 complied with Federal and State requirements, but 50 others did not. Of the 50 that did not comply, 7 contained more than 1 deficiency. The errors in the 50 grouped line items, as well as the discrepancy between the State agency's claim data and the amounts that it claimed for personal care services, occurred because the State agency and the Department of Health and Senior Services (DHSS) did not adequately monitor the personal care services program to ensure that claims for Federal reimbursement complied with certain Federal and State requirements.

We recommended that the State agency (1) refund $26.9 million to the Federal Government, (2) implement procedures to ensure that it adequately supports the costs claimed for personal care services on the CMS-64 reports and maintains that supporting documentation, and (3) work with DHSS to improve its policies and procedures for monitoring the personal care services program for compliance with Federal and State requirements. The State agency agreed with our last two recommendations and described corrective actions that it had taken or planned to take, but it disagreed with our first recommendation regarding the refund to the Federal Government.

Filed under: Center for Medicare and Medicaid Services