Review of Social Security Act Section 1915(c) Waiver Payments for Home and Community-Based Services at Seguin Services, Inc., July 1, 2004, Through June 30, 2005

We estimate the State claimed $77,000 ($39,000 Federal share) during State fiscal year (SFY) 2005 for Medicaid reimbursement paid to Sequin Services, Inc. (Seguin) for home and community-based services (HCBS) that did not comply with Federal and State requirements because Seguin did not provide the services or meet documentation requirements, or the services were unallowable.  Section 1915(c) of the Social Security Act authorizes the HCBS waiver program.  A State's HCBS waiver program must be approved by CMS and allows the State to claim Federal reimbursement for services not usually covered by Medicaid.    

We recommended that the State refund $39,000 to the Federal Government for unallowable HCBS claimed in SFY 2005 and require Seguin to implement internal controls to ensure it documents and claims reimbursement only for allowable HCBS actually provided. The State did not address our first recommendation, indicated that Seguin revised its daily day program attendance record, and stated that Seguin no longer bills for time during the regular day program hours when day program staff take participants to a doctor's appointment.