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Audit (A-07-13-03193)

Missouri Claimed Unallowable Medicaid Payments for Targeted Case Management Services Provided to Individuals With Developmental Disabilities

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The Missouri Department of Social Services, Missouri HealthNet Division's (State agency) payment rates for Targeted Case Management (TCM) services provided and paid for during State fiscal years (SFYs) 2011 through 2013 were not in accordance with the approved State plan. Specifically, the State agency did not calculate the rebased payment rate that was effective at the beginning of SFY 2011 in accordance with the State plan. The State agency increased the SFYs 2012 and 2013 payment rates by the applicable Consumer Price Index in accordance with the State plan. However, because the rebased payment rate was incorrect, the payment rates for SFYs 2011 through 2013 were all incorrect. Any payment rates for subsequent years would also be incorrect.

We recommended that the State agency (1) refund $11.5 million to the Federal Government, (2) adjust future payment rates for TCM services and work with the Centers for Medicare & Medicaid Services to determine the unallowable Medicaid payments that should be refunded to the Federal Government, and (3) follow the State plan requirements for the calculation of rebased payment rates for TCM services.

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