Review of Connecticut Department of Social Services Medicaid Reimbursement for Durable Medical Equipment for Recipients in Skilled Nursing Homes

EXECUTIVE SUMMARY:

We reviewed the Connecticut Department of Social Services' (State Agency's) Medicaid reimbursement procedures and controls over Medicaid payments made to outside suppliers for DME when recipients were also receiving skilled nursing care during their stays in a nursing facility. Most DME are considered routine equipment that are normally supplied by the SNF, the cost of which is included in the SNF Medicaid per diem rates. Our review disclosed that the State Agency has established policies that do not allow for Medicaid reimbursement of most DME services to outside suppliers while a recipient is a resident in a SNF. Based on results of a computer match and related payment testing, we found that the State Agency was adhering to its reimbursement policies and that DME was not being inappropriately charged to the Medicaid program. As a result, we have no further recommendations to make on this issue.

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